Management of patients on antiplatelet antithrombotic NSAIDS in the setting of a kidney biopsy
How should patients on antiplatelet, antithrombotic, and/or nonsteroidal anti-inflammatory agents be managed in the setting of a kidney biopsy?
A discussion regarding the absolute requirement of the biopsy for diagnosis and/or management, risk of thrombosis off medications, and risk of bleeding post-biopsy is necessary in patients on nonsteroidal anti-inflammatory, anti-platelet, and/or antithrombotic agents.
Consultation with hematology and/or cardiology is often required in evaluating the risks and benefits.
Stopping the use of antiplatelet and nonsteroidal anti-inflammatory agents 5 days prior to a kidney biopsy has been shown to reduce the risk of minor complications.
We recommend that patients stop these medications 1 to 2 weeks prior to and following a kidney biopsy.
For patients on warfarin or heparin, there are no definitive guidelines for the management of anticoagulation specific to a kidney biopsy. The recommendations are generalized from studies of open surgical procedures.
• Warfarin should be held prior to the biopsy with a goal international normalized ratio less than 1.5
• Heparin should be stopped at least 4 to 6 hours (preferably up to 24 hours) prior to the biopsy
• Low-molecular-weight heparin should be held 24 hours prior to the procedure
• Anticoagulation medications should be held for 1 week following an uncomplicated biopsy
