Evaluation of risk factors for bleeding after liver biopsy in children

J Pediatr Gastroenterol Nutr. 2012 Jul;55(1):82-7. doi: 10.1097/MPG.0b013e318249c12a.


Objectives: Acetylsalicylic acid is used in liver-transplanted children to prevent thrombosis of the hepatic artery. We evaluated whether acetylsalicylic acid and other risk factors were associated with bleeding after percutaneous liver biopsy.

Methods: Medical charts, laboratory results, imaging studies, and anesthesia charts of 275 ultrasound-guided liver biopsy procedures in 190 children were reviewed. A total of 178 biopsies were performed on native livers and 97 on transplanted livers.

Results: Three major and 28 minor bleeding incidents were found. The mortality rate was 0%. Acetylsalicylic acid had been given the last 5 days before 55 of the biopsy procedures and no increased risk of bleeding was found (odds ratio 0.96 [0.37-2.26]; P = 1.00). Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Acute liver failure was associated with increased risk for major complications (odds ratio 26.1 [3.3-205]; P = 0.01) and was a risk factor for major bleeding. Postbiopsy ultrasound the day after the procedure (n = 266 [96% of 275 biopsies]) revealed minor bleeding after 7.1% of the biopsies and after 2.6% of the ultrasounds revealed unsuspected bleeding, but none of these required intervention.

Conclusions: Ultrasound-guided liver biopsy in children is a procedure with a low rate of major complications and a high rate of minor bleeding not requiring intervention. Treatment with low-dose acetylsalicylic acid did not increase bleeding incidence or total complication rate. Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Routine ultrasound the day after the procedure did not change handling of the patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Aspirin / adverse effects
  • Biopsy / adverse effects
  • Blood Coagulation Disorders / complications
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Female
  • Fibrinolytic Agents / adverse effects
  • Hemoglobins / metabolism
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / etiology*
  • Heparin, Low-Molecular-Weight / adverse effects
  • Humans
  • Infant
  • Infant, Newborn
  • Liver / pathology*
  • Liver Failure, Acute / complications
  • Liver Neoplasms / complications*
  • Liver Transplantation / pathology*
  • Male
  • Odds Ratio
  • Regression Analysis
  • Risk Factors
  • Ultrasonography, Interventional


  • Fibrinolytic Agents
  • Hemoglobins
  • Heparin, Low-Molecular-Weight
  • Aspirin