Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;34(8):1364-1371.
doi: 10.1016/j.jvir.2023.04.015. Epub 2023 Apr 24.

Change in Platelet Count after Transjugular Intrahepatic Portosystemic Shunt Creation: An Advancing Liver Therapeutic Approaches (ALTA) Group Study

Randi J Wong  1 , Jin Ge  1 , Justin Boike  2 , Margarita German  3 , Giuseppe Morelli  4 , Erin Spengler  3 , Adnan Said  3 , Archita Desai  5 , Thomas Couri  6 , Sonali Paul  6 , Catherine Frenette  7 , Elizabeth C Verna  8 , Aparna Goel  9 , Michael Fallon  9 , Bartley Thornburg  10 , Lisa VanWagner  2 , Jennifer C Lai  1 , K Pallav Kolli  11
Affiliations

Change in Platelet Count after Transjugular Intrahepatic Portosystemic Shunt Creation: An Advancing Liver Therapeutic Approaches (ALTA) Group Study

Randi J Wong et al. J Vasc Interv Radiol. 2023 Aug.

Abstract

Purpose: To evaluate recovery of platelet count after transjugular intrahepatic portosystemic shunt (TIPS) creation and patient factors predicting platelet recovery after TIPS creation.

Materials and methods: Adults with cirrhosis who underwent TIPS creation at 9 U.S. hospitals from 2010 to 2015 were included in this retrospective analysis. Change in platelets from before TIPS to 4 months after TIPS creation was characterized. Logistic regression was used to assess factors associated with top quartile percentage platelet increase after TIPS. Subgroup analyses were performed among patients with a pre-TIPS platelet count of ≤50 ×109/L.

Results: A total of 601 patients were included. The median absolute change in platelets was 1 × 109/L (-26 × 109/L to 25 × 109/L). Patients with top quartile percent platelet increase experienced ≥32% platelet increase. In multivariable analysis, pre-TIPS platelet counts (odds ratio [OR], 0.97 per 109/L; 95% CI, 0.97-0.98), age (OR, 1.24 per 5 years; 95% CI, 1.10-1.39), and pre-TIPS model for end-stage liver disease (MELD) scores (OR, 1.06 per point; 95% CI, 1.02-1.09) were associated with top quartile (≥32%) platelet increase. Ninety-four (16%) patients had a platelet count of ≤50 × 109/L before TIPS. The median absolute platelet change was 14 × 109/L (2 × 109/L to 34 × 109/L). Fifty-four percent of patients in this subgroup were in the top quartile for platelet increase. In multivariable logistic regression, age (OR, 1.50 per 5 years; 95% CI, 1.11-2.02) was the only factor associated with top quartile platelet increase in this subgroup.

Conclusions: TIPS creation did not result in significant platelet increase, except among patients with a platelet count of ≤50 × 109/L before TIPS. Lower pre-TIPS platelet counts, older age, and higher pre-TIPS MELD scores were associated with top quartile (≥32%) platelet increase in the entire cohort, whereas only older age was associated with this outcome in the patient subset with a pre-TIPS platelet count of ≤50 × 109/L.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow diagram of patients included in the study. TIPS = transjugular intrahepatic portosystemic shunt.
Figure 2.
Figure 2.
Histogram of change in platelet count at 4 months after transjugular intrahepatic portosystemic shunt (percentage).
Figure 3.
Figure 3.
Four months post-TIPS platelet count versus pre-TIPS platelet counts. TIPS = transjugular intrahepatic portosystemic shunt.
See this image and copyright information in PMC

Comment in

References

    1. LaBerge JM. Transjugular intrahepatic portosystemic shunt—role in treating intractable variceal bleeding, ascites, and hepatic hydrothorax. Clin Liver Dis 2006; 10:583–598, ix. - PubMed
    1. Caldwell SH, Hoffman M, Lisman T, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assessment of current management. Hepatology 2006; 44:1039–1046. - PubMed
    1. Northup PG, Garcia-Pagan JC, Garcia-Tsao G, et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:366–413. - PubMed
    1. Hayashi H, Beppu T, Shirabe K, Maehara Y, Baba H. Management of thrombocytopenia due to liver cirrhosis: a review. World J Gastroenterol 2014; 20:2595–2605. - PMC - PubMed
    1. Moore AH. Thrombocytopenia in cirrhosis: a review of pathophysiology and management options. Clin Liver Dis (Hoboken) 2019; 14:183–186. - PMC - PubMed

Publication types