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SIR 2026

Traditional Poster

Interventional Oncology

Ablation

Session: Traditional Poster Presentations

553 - Retrospective Review of Complications Following Hepatic Histotripsy in Patients Receiving Uninterrupted Anticoagulation and Antiplatelet Therapies

Monday, April 13, 2026
12:10 PM - 1:10 PM ET
Purpose: Periprocedural hold of anticoagulation or antiplatelet (AC/AP) therapy is recommended for patients undergoing ablative therapies to the liver, but can increase the risk of thromboembolic events and create logistical challenges for patients and providers. Given the unique treatment properties of histotripsy it is hypothesized that histotripsy in anticoagulated subjects does not increase bleeding risk. The purpose of this study was to retrospectively evaluate the bleeding risk and complications after histotripsy in an early cohort of patients with ongoing AC/AP therapy during treatment.

Materials and Methods: Single center, retrospective review of all hepatic histotripsy patients (n=30) to identify patients on concurrent AC/AP therapy. A total of 11 patients (8 male, 3 female, mean age 62.9 ± 9.6 years) were identified and underwent 12 treatment sessions for the treatment of 16 liver tumors. Medical records were reviewed for data on AC/AP type and dosing, INR, platelet count, and all complications for 30 post-treatment. Immediate post-procedure and 1-month follow-up images were reviewed for bleeding complications, portal vein thrombus (PVT), and blood vessel injury. Complications were graded according to the SIR Adverse Event Classification.

Results: Patients received aspirin 81 mg (3/12), aspirin 325 mg (1/12), clopidogrel (1/12), apixaban (3/12), or pre-treatment intraprocedural heparin only (4/12). The mean INR at the time of treatment was 1.1 ± 0.1, and the mean platelet count was 199 ± 72 (1,000 cells/mm3). No bleeding-related complications occurred (0/12). Adverse events included one moderate (PVT occurring immediately post-procedure, treated with IV heparin and oral AC, fully resolved) and three mild events (no treatment required). No blood vessel injury was observed on post-procedure or follow-up imaging.

Conclusion: Hepatic histotripsy appears to be safe for patients on AC/AP therapy. Larger studies are warranted to fully define safety outcomes and anti-coagulant regimens in the setting of histotripsy.