Liver and Bile
Eur J Gastroenterol Hepatol. 2022;34(2):192–9
Procedural bleeding risk, rather than conventional coagulation tests, predicts procedure-related bleeding in cirrhosis
Background: Standard coagulation parameters are used to guide prophylactic blood product transfusion prior to invasive procedures in cirrhotic patients despite limited high-quality evidence.
Aims: The authors aimed to describe coagulation parameters and prophylactic blood product use in cirrhotic patients having invasive procedures, and the influence of both on periprocedural bleeding.
Methods: They conducted a cohort study of cirrhotic patients undergoing invasive procedures at a referral hospital. Procedures were classified into low or moderate-high bleeding risk. Prophylactic blood component was defined as fresh frozen plasma, cryoprecipitate or platelet transfusion prior to procedures. Univariate and multivariate logistic regression was performed to identify factors associated with procedure-related bleeding.
Results: 566 procedures in 233 cirrhotic patients were identified. Prophylactic blood product was given before 16% of high-risk and 11% of low-risk procedures (p = 0.18). Eight (8.3%) high-risk procedures were complicated by postprocedural bleeding, 6 of which occurred in patients without significant coagulopathy. The bleeding rate for low-risk procedures was 0.4%. For patients with international normalized ratio (INR) > 1.5, platelet count < 50 x 109/l, or both, the rate of bleeding was comparable between those given and not given prophylactic blood products (3.1% vs. 1.9%; p = 0.63). After adjusting for age, sex, platelet count, INR, acute kidney injury, sepsis and Model for End-stage Liver Disease, the only factor significantly predicting procedure-related bleeding was the procedural bleeding risk category (p
Conclusions: Procedure-related bleeding in cirrhotic patients cannot be accurately predicted by international normalized ratio or platelet count, nor prevented by blood component prophylaxis using these parameters. Procedure-related bleeding is best predicted by the bleeding risk status of procedures.