An Elderly Man with a Swollen Knee,Significant Ecchymosis, and Minimal Knee Pain

A 72-year-old man presents with left knee pain and swelling over several days. The pain and swelling started after he felt a "pop" when bending to pick up an object off the floor. His past medical history is significant for type 2 diabetes mellitus. Physical exam revealed significant ecchymosis on the anterolateral aspect of the thigh. There was a minimal amount pain upon knee flexion.

Incidence of bleeding complications after percutaneous core needle biopsy in hypertensive patients and comparison to normotensive patients

PURPOSE

To retrospectively determine the rate of major bleeding complications after solid organ or lung biopsy in patients with hypertension and compare to the rates of bleeding in normotensive patients.

MATERIALS AND METHODS

Following IRB approval, retrospective review of all solid organ and lung biopsies performed at our institution between June 1st, 2013 and October 31st, 2015 was performed. Hypertension was defined as a maximum observed systolic blood pressure of 160 mmHg or greater and/or diastolic blood pressure of 90 mmHg or greater at the time of the biopsy procedure. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 4.0) established by the National Cancer Institute.

RESULTS

4756 total biopsies in 3876 unique patients (median age 60, 57% male) were included. 1488 (31.3%) of these biopsies were performed in hypertensive patients. Fifteen major hemorrhages (CTCAE grade 3 or higher) occurred (0.32%). There were no deaths. There was no significant association between hypertension and major bleeding. The incidence of bleeding in hypertensive patients was 0.40% (6/1488), which was not statistically different than the incidence in normotensive patients (9/3268, 0.28%, p = 0.496). For the subgroup of native renal parenchymal biopsies, the rate of bleeding was slightly higher in hypertensive patients (3/213, 1.4% vs. 1/355, 0.28% in normotensive patients) but remained low, and the difference was not statistically significant (p = 0.188).

CONCLUSION

The overall incidence of major bleeding after percutaneous biopsy is very low. Hypertension does not appear to significantly increase the risk of major bleeding complications.