November 29, 2025
Background: Percutaneous liver procedures are frequently performed in patients with abnormal coagulation tests. Current guidelines suggest prophylactic transfusion is not mandatory in all patients with liver disease or cirrhosis, depending on the risk of bleeding. This study aims to describe the incidence and risk of major bleeding after percutaneous liver procedures in patients with and without cirrhosis.
Methods: This retrospective study included patients who underwent percutaneous liver biopsy and radiofrequency and microwave ablation of liver lesions at three centers in Spain. A transfusion protocol was considered for platelet counts <50,000 and/or international normalized ratio >1.5. The primary outcome was major bleeding.
Results: A total of 1,797 patients were included in the study, with 316 having cirrhosis (18%) and 1,481 without cirrhosis (82%). Among the patients with cirrhosis, 80 were classified as Child A, and percutaneous liver biopsy was the most frequent procedure (86%). Fourteen patients (0.8%) experienced major bleeding, with 0.4% occurring after radiofrequency and microwave ablation and 0.8% after percutaneous liver biopsy. Bleeding occurred in 0.6% of patients with cirrhosis compared with 0.8% in those without (p = ns). No clinical or procedural variables were associated with bleeding. Twenty-five patients (1.4%) had an international normalized ratio >1.5, and 22 patients (1.2%) had a platelet count <50,000. Only 24% (6/25) of patients with an international normalized ratio >1.5 received prophylactic transfusion.
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