Procedure-related bleeding risk in patients with cirrhosis and severe thrombocytopenia

Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy. Fondazione IRCCS Casa Sollievo della Sofferenza, Division of Gastroenterology, San Giovanni Rotondo, Foggia, Italy. Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy. Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, Academic Hospital, Udine, Italy. I Clinica Medica, Sapienza University of Rome, Rome, Italy.

European journal of clinical investigation. 2021;:e13508
BACKGROUND Gaps of knowledge still exist about the potential association between severe thrombocytopenia and increased risk of procedure-associated bleeding in patients with liver disease. METHODS In this narrative review we aimed at examining the association between procedure-related bleeding risk and platelet count in patients with cirrhosis and severe thrombocytopenia in various settings. We updated to 2020 a previously conducted literature search using MEDLINE/PubMed and EMBASE. The search string included clinical studies, adult patients with chronic liver disease and thrombocytopenia undergoing invasive procedures, any interventions and comparators, and haemorrhagic events of any severity as outcome. RESULTS The literature search identified 1,276 unique publications, 15 studies met the inclusion criteria and were analysed together with those identified by the previously search. Most of the new studies included in our analysis did not assess the association between post-procedural bleeding risk and platelet count alone in patients with chronic liver disease. Furthermore, some results could have been biased by prophylactic platelet transfusions. A few studies found that severe thrombocytopenia may be predictive of bleeding following percutaneous liver biopsy, dental extractions, percutaneous ablation of liver tumours, and endoscopic polypectomy. CONCLUSIONS Currently available literature cannot support definitive conclusions about the appropriate target platelet counts to improve the risk of bleeding in cirrhotic patients who underwent invasive procedures; moreover, it showed enormous variability in the use of prophylactic platelet transfusions.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine