Effects of aspirin on kidney biopsy bleeding complications - a systematic review and meta-analysis (PROSPERO 2021 CRD42021261005).

Post-procedural bleeding is the main complication of percutaneous kidney biopsy (PKB). Therefore, aspirin is routinely withheld in patients undergoing PKB to reduce the bleeding risk. The authors aimed to examine the association between aspirin use and bleeding during PKB. This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The article search was performed on the MEDLINE and SCOPUS using queries specific to each database. Article inclusion was limited to primary studies. The meta-analysis compared the risk of major bleeding events between the aspirin-exposed versus nonexposed group. Pooled effect estimate was examined using random-effects presented as odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed through Cochrane I2 test statistics. Sensitivity and subgroup analyses were also performed according to kidney type. Ten studies were included in the review and four studies were included in the meta-analysis, reviewing a total of 34067 PKB. Definitions for significant aspirin exposure were inconsistent between studies, limiting comparisons. Studies with broader definitions for aspirin exposure mostly showed no correlation between aspirin use and post-biopsy bleeding. Studies with strict definitions for aspirin exposure found an increased risk for haemorrhagic events in the aspirin-exposed group. No significant differences were found between aspirin-exposed and the comparison group regarding major bleeding events [OR 1.72; 95% CI 0.50-5.89, I2 = 84%]. High-quality evidence on the effect of aspirin on the bleeding risk is limited. Our meta-analysis did not show a significantly increased risk for major bleeding complications in aspirin-exposed patients. Further studies are needed to define a more comprehensive approach for clinical practice.