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. 2018 Jul-Aug;24(4):220-227.
doi: 10.4103/sjg.SJG_486_17.

Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis

Jing Li  1 , Bing Han  2 , Hongyu Li  1 , Han Deng  3 , Nahum Méndez-Sánchez  4 , Xiaozhong Guo  1 , Xingshun Qi  1
Affiliations

Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis

Jing Li et al. Saudi J Gastroenterol. 2018 Jul-Aug.

Abstract

Background/aim: Bleeding risk among patients with acute or chronic liver disease after invasive procedures is a common concern in clinical practice. This retrospective study aimed to explore whether the presence of coagulopathy increased the risk of major bleeding after invasive procedures in cirrhosis.

Patients and methods: A total of 874 cirrhotic patients underwent invasive procedures. Coagulopathy was defined as international normalized ratio (INR) ≥1.5 and/or platelets (PLTs) ≤50 × 109/L. Severe thrombocytopenia was defined as PLTs ≤ 50 × 109/L. Invasive procedures, major bleeding after invasive procedures, and in-hospital deaths were recorded.

Results: In all, 296 patients (33.9%) had coagulopathy. Major bleeding after invasive procedures occurred in 21 patients (2.4%). Major bleeding after invasive procedures was more frequent in patients with coagulopathy than those without coagulopathy (4.1% vs 1.6%, P = 0.023). Major bleeding after invasive procedures was more frequent in patients with severe thrombocytopenia than those without severe thrombocytopenia (4.9% vs 1.6%, P = 0.008). Incidence of major bleeding after invasive procedures was not significantly different between patients with INR ≥ 1.5 and INR < 1.5 (4.5% vs 2.0%, P = 0.065). Patients with INR ≥1.5 had a significantly higher in-hospital mortality than those with INR < 1.5 (6.4% vs 1.3%, P < 0.001).

Conclusion: Severe thrombocytopenia significantly increased the risk of major bleeding after invasive procedures in cirrhosis. INR ≥ 1.5 significantly increased in-hospital mortality.

Keywords: In-hospital mortality; international normalized ratio; platelets; prothrombin time; thrombocytopenia.

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Conflict of interest statement

There are no conflicts of interest

References

    1. Muciño-Bermejo J, Carrillo-Esper R, Uribe M, Méndez-Sánchez N. Coagulation abnormalities in the cirrhotic patient. Ann Hepatol. 2013;12:713–24. - PubMed
    1. Northup PG, Caldwell SH. Coagulation in liver disease: A guide for the clinician. Clin Gastroenterol Hepatol. 2013;11:1064–74. - PubMed
    1. Tripodi A, Primignani M, Mannucci PM. Abnormalities of hemostasis and bleeding in chronic liver disease: The paradigm is challenged. Intern Emerg Med. 2010;5:7–12. - PubMed
    1. De Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52. - PubMed
    1. Tripodi A. The coagulopathy of chronic liver disease: Is there a causal relationship withbleeding? No. Eur J Intern Med. 2010;21:65–9. - PubMed

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