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Bleeding after invasive procedures is rare and unpredicted by platelet counts in cirrhotic patients with thrombocytopenia

Published:December 15, 2016DOI:https://doi.org/10.1016/j.ejim.2016.11.007

      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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