Table 2.

Recommended interval for discontinuation of antiplatelet and anticoagulant medication prior to liver biopsy

Drug	Dose	Stop	Notes
Clopidogrel, prasugrel, ticagrelor		7 Days	If cannot delay for 7 days stop clopidogrel for 24 hours; platelet transfusion may be used but transjugular liver biopsy route is recommended
Aspirin		3–7 Days prior to elective procedures	For urgent biopsies, aspirin can be continued at the discretion of the clinician
Dual antiplatelet therapy—for example, aspirin/clopidogrel		Consider if biopsy can be delayed or if clopidogrel can be stopped. Always continue aspirin	Many patients receiving this antiplatelet combination have cardiac stents
Dipyridamole		Omit on day of biopsy
Low molecular weight heparin	Prophylactic dose	12 Hours before procedure
	Higher than prophylactic dose	24 Hours before procedure
Direct oral anticoagulants		Omit for 2 days before procedure	Omit for longer if dabigatran and renal impairment