Risk of Bleeding Complications in Percutaneous Biliary Drainage: The Paradox of the Normal Hemostasis

Abstract

Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. >Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.

The risk of bleeding complications on percutaneous biliary drainage in patients with abnormal hemostasis

“…Nenstiel et al (19) reported the rate of bleeding complications as 13% in their study in patients with normal hemostasis, and as 15.8% in the study of Hougton et al (14) including patients with abnormal hemostasis with corrected hemostasis. In our study, this rate was 19.3%, and we think that this is related to the patient population.…”

“…Studies on PBD have generally evaluated bleeding complications in patients with normal hemostasis, and studies on patients with abnormal hemostasis are limited (5,7,9,13,14). To the best of our knowledge, our study is the first study to group and evaluate patients with abnormal hemostasis.…”

“…PBD is a safe and widely practiced interventional radiology procedure for biliary obstructions (14,18).…”

“…In our study, the rate of bleeding in patients whose abnormal hemostasis could not be corrected was higher than those whose hemostasis was corrected. Hougtan et al reported a lower rate of bleeding complications in patients with corrected hemostasis than those with normal hemostasis, and did not analyze correction of hemostasis as a possible risk factor (14). This difference is due to the small number of patients whose hemostasis was corrected in the study of Hougtan et al 5) in a retrospective study in which they analyzed the risk factors for the development of bleeding complications in the PBD procedure; reported that platelet count of 50000/mm3 or less and INR of 1.5 or more were risk factors, but it was not statistically significant in multivariate analysis.…”

“…In studies on the risk of bleeding complications after PBD, patients with normal hemostasis were generally evaluated (11)(12)(13). A limited number of studies have compared those with corrected abnormal hemostasis with those with normal hemostasis (14). However, although there are comparative studies on patients whose hemostasis cannot be corrected in some image-guided procedures, there is no study on PBD (15)(16)(17).…”