Real-Time Ultrasound-Guided Paracentesis by Radiologists: Near Zero Risk of Hemorrhage without Correction of Coagulopathy

J Vasc Interv Radiol. 2019 Feb;30(2):259-264. doi: 10.1016/j.jvir.2018.11.001.


Purpose: To evaluate the rate and risk factors for hemorrhage in patients undergoing real-time, ultrasound-guided paracentesis by radiologists without correction of coagulopathy.

Materials and methods: This was a retrospective study of all patients who underwent real-time, ultrasound-guided paracentesis at a single institution over a 2-year period. In total, 3116 paracentesis procedures were performed: 757 (24%) inpatients and 2,359 (76%) outpatients. Ninety-five percent of patients had a diagnosis of cirrhosis. Mean patient age was 56.6 years. Mean international normalized ratio (INR) was 1.6; INR was > 2 in 437 (14%) of cases. Mean platelet count was 122 x 103/μL; platelet count was < 50 x 103/μL in 368 (12%) of patients. Seven hundred seven (23%) patients were dialysis dependent. Patients were followed for 2 weeks after paracentesis to assess for hemorrhage requiring transfusion or rescue angiogram/embolization. Univariate analysis was performed to determine risk factors for hemorrhage. Blood product and cost saving analysis were performed.

Results: Significant post-paracentesis hemorrhage occurred in 6 (0.19%) patients, and only 1 patient required an angiogram with embolization. No predictors of post-procedure bleeding were found, including INR and platelet count. Transfusion of 1125 units of fresh frozen plasma and 366 units of platelets were avoided, for a transfusion-associated cost savings of $816,000.

Conclusions: Without correction of coagulation abnormalities with prophylactic blood product transfusion, post-procedural hemorrhage is very rare when paracentesis is performed with real-time ultrasound guidance by radiologists.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care
  • Blood Coagulation Disorders / blood*
  • Blood Coagulation Disorders / complications
  • Blood Coagulation Disorders / diagnosis
  • Blood Coagulation Disorders / economics
  • Blood Coagulation*
  • Blood Transfusion
  • Cost Savings
  • Cost-Benefit Analysis
  • Hemorrhage / blood
  • Hemorrhage / economics
  • Hemorrhage / etiology*
  • Hemorrhage / therapy
  • Hospital Costs
  • Humans
  • International Normalized Ratio
  • Middle Aged
  • Paracentesis / adverse effects*
  • Paracentesis / economics
  • Paracentesis / methods*
  • Platelet Count
  • Radiologists* / economics
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional* / economics