Risk of complications with use of aspirin during renal biopsy: A systematic review

Background: Bleeding is a well-known complication of percutaneous renal biopsy (PRB). Thus, antiplatelet agents are routinely held for most patients undergoing elective PRB to decrease bleeding risk. Materials and methods: In this systematic review, we examine the association between antiplatelet use and bleeding during PRB. MEDLINE and EMBASE were searched from inception to December 2016 using terms that included renal biopsy, antiplatelet,aspirin, and bleeding. Guidelines and systematic reviews were identified primarily through large databases, including the National Guideline Clearinghouse and Cochrane Database of Systematic Reviews. Two authors independently screened the results, and appraised and graded the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Out of 371 guidelines, 40 systematic reviews, and 709 primary studies originally identified, 4 guidelines, 1 systematic review, and 2 primary studies met inclusion criteria. The guidelines recommend halting aspirin for elective PRB. The systematic review found no difference in major outcomes for PRB in patients for whom aspirin was continued versus halted, but was of low quality. The 2 nonrandomized primary studies in PRB patients managed with and without aspirin found no difference in major bleeds but a higher risk of minor bleeds. Conclusions: There is low-quality evidence on the effect of aspirin on bleeding risk from PRB. It is reasonable to discontinue aspirin 7-10 days prior to nonemergent biopsies, in accordance with guidelines. Given the results from the primary studies, it is reasonable to perform randomized controlled trials to obtain high-quality evidence to inform clinical practice.