Systematic review with meta-analysis: abnormalities in the international normalised ratio do not correlate with periprocedural bleeding events among patients with cirrhosis

Department of Internal Medicine, Novant Forsyth Medical Center, Winston Salem, NC, USA. Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA. Department of Internal Medicine, Tenova Cleveland Hospital, Cleveland, TN, USA. Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA. Department of Internal Medicine, Division of Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA. Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases & Transplantation, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.

Alimentary pharmacology & therapeutics. 2020;52(8):1298-1310
BACKGROUND Cirrhotic coagulopathy is a delicate interplay comprising deficiencies of both procoagulant and anticoagulant factors. AIM: To identify the relationship between international normalised ratio [INR] with periprocedural bleeding risk among patients with cirrhosis. METHODS Following a thorough database search of the primary literature, 29 studies were targeted for analysis, including 13 276 patients with cirrhosis undergoing indicated procedures. RESULTS There was no significant association between periprocedural bleeding events and pre-procedural INR [pooled odds ratio 1.52; 95% CI 0.99, 2.33; P = 0.06]. Furthermore, there was no significant difference in mean INR [pooled mean difference 0.05; 95% CI -0.03, 0.13; P = 0.23] upon comparison of patients who either did or did not experience a periprocedural bleeding event. Significant heterogeneity among some studies was primarily fuelled by significant subgroup effects of both specific procedure types performed. Additionally, there were markedly inconsistent transfusion practices across studies. CONCLUSIONS INR fails to serve as a significant correlate for periprocedural bleeding events among patients with cirrhosis. Ideally, these new findings will help serve as a springboard for future studies, as well as to minimize transfusion of blood products, which command a myriad of adverse effects among patients with cirrhosis.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine