title: Bleeding Rate for Ultrasound-Guided Paracentesis in Thrombocytopenic Patients.
abstract: OBJECTIVE
  The purpose of this study was to determine the rate of major bleeding complications for ultrasound-guided paracentesis performed in thrombocytopenic patients.
  
  
  METHODS
  We retrospectively reviewed the electronic medical records of patients with platelet counts of less than 50,000/μL who had ultrasound-guided paracenteses performed in the Department of Radiology without correcting preprocedural platelet transfusions between 2005 and 2011. Medical records were evaluated for evidence of major bleeding complications (grade 3 or higher as defined by the National Institutes of Health's Common Terminology Criteria for Adverse Events, version 4.03) and their clinical sequelae. Platelet count and bleeding complications were evaluated for an association, and a sensitivity analysis was performed to determine whether analysis of a control group of patients without thrombocytopenia would yield added confidence in this assessment.
  
  
  RESULTS
  Among 304 procedures in 205 thrombocytopenic patients (69% male; mean age ± SD, 56.6 ± 11.9 years), the mean platelet count was 38,400 ± 9300/μL (range, 9000-49,000/μL). Three major bleeding complications requiring red blood cell transfusion were observed in patients with platelet counts of 41,000 to 46,000/μL, for a complication rate of 0.99% (95% confidence interval, 0.3%-2.9%). No patient required an additional procedure or died because of the bleeding complication. There was no association of platelet count with bleeding complications. The sensitivity analysis showed that further evaluation of patients with normal platelet counts would not add to the conclusion.
  
  
  CONCLUSIONS
  The risk of major bleeding after ultrasound-guided paracentesis in thrombocytopenic patients is very low. In most patients, routine assessment of the preprocedural serum platelet concentration is not necessary, and correction of such an abnormal laboratory value is not indicated.
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.). kurup.anil@mayo.edu.
authors.forename: A Nicholas
authors.initials: AN
authors.lastname: Kurup
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Lekah
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Scott T
authors.initials: ST
authors.lastname: Reardon
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Grant D
authors.initials: GD
authors.lastname: Schmit
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Callstrom
authors.affiliation: Department of Radiology (A.N.K., A.L., G.D.S., J.S.M., M.R.C., T.D.A.), Division of Gastroenterology and Hepatology, Department of Internal Medicine (P.S.K.), and Department of Biomedical Statistics and Informatics (R.E.C.), Mayo Clinic, Rochester, Minnesota USA; and Department of Radiology, Essentia Health, Fargo, North Dakota USA (S.T.R.).
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Atwell
mesh_terms: D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D019152:Paracentesis / Q000706:statistics & numerical data*; D017713:Platelet Transfusion / Q000706:statistics & numerical data*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*
keywords: complications; paracentesis; thrombocytopenia; ultrasound-guided paracentesis