Highlights
- •It is recommended to infuse PLT units whenever cell numbers fall below 50 × 103/L.
- •Liver cirrhosis, is considered as a re-balanced hemostatic state.
- •In our cirrhotics undergoing invasive procedures, bleeding was a rare event.
- •Bleeding was unpredicted by circulating platelet numbers.
- •Prophylactic infusion of platelet concentrates did not prevent bleeding.
Abstract
Background
In cirrhotics with low circulating platelets (PLT), restoration of normal cell counts
has been traditionally recommended before invasive procedures. However, there is neither
consensus on the PLT transfusion threshold nor evidence of its clinical efficacy.
Patients
In order to fill this gap of knowledge, we prospectively collected and analyzed data
on circulating PLT counts [and International Normalized Ratio (INR)] values in a case
series of 363 cirrhotics scheduled to undergo invasive investigations. PLT and/or
fresh-frozen plasma (FFP) units were infused at the discretion of the attending physician,
and the occurrence of post-procedural bleeding was related to pre-and post-infusion
results.
Results
852 Procedures were carried out in 363 cirrhotics sub-grouped according to the Child-Pugh-Turcotte
(CPT) classification (class A/B/C: 124/154/85). The infusion of PLT and/or FFP improved
only marginally circulating PLT counts and INR values. Ten post-procedural bleeds
occurred in the whole case series, i.e. 1 episode every 85 procedures or every 36
patients. Post-procedural bleeding was unrelated to the PLT counts, to the degree
of INR abnormalities, nor to the CPT classes, but was more frequent in patients who
underwent repeated investigations. In the 10 patients with the most profound alterations
in PLT and/or INR values, no post-procedural bleeding occurred.
Conclusions
In cirrhotic patients with low PLT and/or abnormal INR values undergoing invasive
investigations, post-procedural bleeding was rare and unpredicted by PLT counts or
abnormal INR values. In particular, the recommendation to infuse platelets when counts
are <50 × 103/L is not substantiated by this case series of cirrhotic patients.
Keywords
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Article info
Publication history
Published online: December 15, 2016
Accepted:
November 8,
2016
Received in revised form:
October 21,
2016
Received:
June 14,
2016
Footnotes
☆I certify that myself or any of the co-authors have no actual or potential conflict of interest in relation to this article.
Identification
Copyright
© 2016 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
