Incidence of Bleeding Following Invasive Procedures in Patients With Thrombocytopenia and Advanced Liver Disease

Published on Oct 1, 2010in Clinical Gastroenterology and Hepatology8.549
· DOI :10.1016/J.CGH.2010.06.018
Edoardo G. Giannini57
Estimated H-index: 57
(UniGe: University of Genoa),
Alfredo Greco4
Estimated H-index: 4
(UniGe: University of Genoa)
+ 3 AuthorsVincenzo Savarino70
Estimated H-index: 70
(UniGe: University of Genoa)
Background & Aims Patients with advanced liver disease often undergo invasive procedures, so the combination of thrombocytopenia, coagulopathy, and bleeding should be carefully assessed. We evaluated the prevalence of thrombocytopenia in a series of patients with liver cirrhosis who were being evaluated for orthotopic liver transplantation (OLT) and determined the number of invasive procedures and procedure-related incidences of bleeding in patients with thrombocytopenia. Methods We studied 121 consecutive patients who were being evaluated for OLT. Thrombocytopenia was defined as a platelet count 1.5. Invasive procedures and incidences of procedure-related bleeding were recorded for each patient. Results The prevalence of thrombocytopenia and severe thrombocytopenia were 84% and 51%, respectively. Among the 102 thrombocytopenic patients, 50 (49%) underwent an invasive procedure (32 with severe thrombocytopenia; 64%). Bleeding occurred in 10 of the patients who underwent an invasive procedure (20%). Among the 50 patients who underwent invasive procedure, 32 had severe thrombocytopenia and 18 had moderate thrombocytopenia. Bleeding occurred in 10 of the 32 patients (31%) with severe thrombocytopenia and in none of those with moderate thrombocytopenia. There was no difference in prevalence of significant coagulopathy between patients with severe thrombocytopenia who underwent invasive procedure and bled (3/10; 30%) and those who did not bleed (10/22; 45%). Conclusions Thrombocytopenia has a high prevalence among patients with advanced liver disease. Bleeding related to invasive procedures occurs most frequently in patients with severe thrombocytopenia, whereas significant coagulopathy does not seem to be associated with bleeding.
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