Holding Jardiance for Liver Biopsy
Jardiance (empagliflozin) does not need to be held before a liver biopsy, as there is no evidence-based requirement to discontinue SGLT2 inhibitors for this procedure.
Rationale
The British Society of Gastroenterology guidelines on liver biopsy 1 provide comprehensive recommendations for medication management before liver biopsy, specifically addressing anticoagulants and antiplatelet agents that affect bleeding risk. Notably, SGLT2 inhibitors like empagliflozin are not mentioned in these guidelines as medications requiring discontinuation.
Medications That DO Require Holding
The guidelines specifically recommend stopping 1:
- Aspirin: 3 days prior (though decision depends on indication urgency)
- Direct oral anticoagulants (DOACs): 2 days prior to biopsy
- Dabigatran: Longer hold depending on renal function
- Warfarin: Adjust based on INR targets
Why Jardiance is Different
Empagliflozin does not:
- Affect coagulation or bleeding risk
- Interfere with the biopsy procedure itself
- Impact wound healing or infection risk
- Require special consideration for hepatic procedures
The FDA label for Jardiance 2 does not list any precautions or contraindications related to surgical or invasive procedures, including liver biopsy.
Clinical Considerations
The primary concerns for liver biopsy relate to bleeding risk, which is why anticoagulants and antiplatelet agents are addressed 1. Empagliflozin's mechanism of action (inhibiting glucose reabsorption in the kidney) has no bearing on these risks.
Safety in Liver Disease
Recent evidence demonstrates empagliflozin is safe even in advanced liver disease 3, with no increased adverse events in patients with compensated or decompensated cirrhosis. This further supports that there is no reason to hold the medication for a liver biopsy procedure.
Practical Recommendation
- Continue Jardiance through the liver biopsy procedure
- No need to hold before or restart after the procedure
- Focus medication management on anticoagulants and antiplatelet agents as outlined in the guidelines 1
The only scenario where you might consider holding Jardiance would be if the patient is NPO (nothing by mouth) for an extended period around the procedure, but this would be a practical consideration rather than a safety requirement, and the medication can simply be resumed with the next meal.