Thromboelastography versus bleeding time for risk of bleeding post native kidney biopsy

Abstract

Introduction: The risk of bleeding has led to screening of the primary hemostasis before renal biopsy. A bleeding time test (BT) is considered standard practice, but reliance on this test is controversial and its benefits remain questionable. A possible alternative is thromboelastography (TEG). However, data regarding TEG in patients with renal dysfunction is limited. Objectives: To determine TEG abnormalities and their consequences in patients who underwent a native kidney biopsy. Methods: A retrospective study of 417 consecutive percutaneous native renal biopsies performed in our Center. If serum creatinine >1.5 mg/dL, the patient underwent either a BT test (period A, January 2015-31 December 2016) or TEG (period B, January 2017-August 2018). In patients with prolonged BT, or an abnormal low maximal amplitude (MA) parameter of TEG, or suspected clinical uremic thrombopathy, the use of desmopressin acetate (DDAVP) was considered. Results: Most biopsies (90.6%) were done by the same dedicated radiologist. Fifty-one patients had a BT test, which was normal in all tested patients. Seventy-one patients underwent TEG, and it was abnormal in 34 of them, most patients had combined abnormalities. The only parameter related to abnormal TEG was older age (Odds Ratio 1.21 [95% CI 1.09-2.38] p ¼ 0.04 for abnormal Kinetics; OR 1.37 (1.05-1.96) p ¼ 0.037 for abnormal MA). Twenty-six patients (6.23%) had bleeding complications. Risk of bleeding was significantly related to age (1.4 [1.11-7.48] p ¼ 0.04), systolic blood pressure (1.85 [1.258-9.65] p ¼ 0.02), and serum creatinine (1.21 [1.06-3.134] p ¼ 0.048). Conclusions: TEG abnormalities in patients with renal dysfunction are variable and fail to predict bleeding during kidney biopsy. The decision to administer DDAVP as a preventive measure during these procedures should be based on clinical judgment only.

Case Report: Hyponatremia Secondary to Desmopressin Administration Prior to Percutaneous Kidney Biopsy: A Case-Based Review

“…Most of studies evaluated the effect of desmopressin on bleeding complications and did not use post-biopsy serum sodium monitoring protocols (16). Accordingly, there is scarce data regarding the risk of hyponatremia after a prophylactic single-dose desmopressin prior to kidney biopsy (Table 2) (4,23,25,26,(28)(29)(30)(31)(32)(33).…”

“…Initially, desmopressin was indicated prior to renal biopsy only in patients suspected or previously diagnosed with thrombophilia, and in those with a prolonged bleeding time ( 13 , 22 – 26 ). As the relation between bleeding time and bleeding complications after renal biopsy was not uniformly proved, the need of assessing bleeding time was thereafter questioned ( 23 , 24 , 27 ).…”

Thromboelastography in the Perioperative Period: A Literature Review

“…TEG was also used in monitoring hematological outcomes in urological procedures such as prostatectomy [ 213 , 214 ] and renal biopsy [ 215 ] or even in nephrotic syndrome patients [ 216 ]. However, its efficacy was questionable as in prostatectomy procedures, TEG clot lysis correlated with bleeding [ 214 ] while other parameters like TEG-LY30 and TEG-LY40 were not able to predict postoperative coagulopathy [ 213 ].…”

“…However, its efficacy was questionable as in prostatectomy procedures, TEG clot lysis correlated with bleeding [ 214 ] while other parameters like TEG-LY30 and TEG-LY40 were not able to predict postoperative coagulopathy [ 213 ]. Also, during the renal biopsy, TEG-MA was not effective to predict bleeding time [ 215 ]. However, TEG parameters like TEG-MA, TEG-R, TEG-K, and TEG α-angle were associated with coagulopathy complications and could distinguish different renal pathologies in 713 Chinese nephrotic syndrome patients [ 216 ].…”