REPLY
Decreasing Liver Biopsy Complications
Keith D. Lindor and
Christine H. Janes
1 September 1993 | Volume 119 Issue 5 | Pages 436-437
IN RESPONSE:
We agree particularly with the difficulty in the use and interpretation of tests designed to predict the risk for bleeding in patients having liver biopsies. The ISI during the time of this study was approximately 2.73. The INR was not being reported by our laboratory during the time of this study. Furthermore, as Kovacs and colleagues point out, the ISI is useful for comparison of prothrombin times of patients receiving oral anticoagulants and has not been adequately examined for value in predicting bleeding risks in patients who are not receiving anticoagulants. We agree that bleeding time has also been an unreliable predictor of bleeding risks. We do not routinely use it unless we suspect platelet dysfunction. The criteria we presented have been useful for many years at the Mayo Clinic, but we would welcome other more reliable predictors.
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