Procedure-related bleeding risk in patients with cirrhosis and severe thrombocytopenia
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.
Thrombopoietin receptor agonists and risk of portal vein thrombosis in patients with liver disease and thrombocytopenia: A meta-analysis
Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2018;51((1):):24-27
BACKGROUND Treatment of thrombocytopenia with thrombopoietin receptor agonists (TPORAs) seems to be associated with portal vein thrombosis (PVT) in patients with chronic liver disease (CLD). We performed a meta-analysis of the trials carried out in this clinical setting to assess if such association is detectable. METHODS We performed a meta-analysis with studies that compared the effect of TPORAS vs placebo in patients with CLD and thrombocytopenia. RESULTS Four studies, including 1953 patients, reported the incidence of PVT in patients with CLD and thrombocytopenia treated with TPORAs or placebo. No significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.8; 95% C.I., 0.97-8.16; p=0.055). A significant association between PVT and TPORAs was observed only in patients treated with eltrombopag (O.R.: 3.8; 95% C.I., 1.14-13.2; p=0.03). Three studies, including 514 patients who were undergoing an elective invasive procedure, analyzed the incidence of PVT in TPORAs-treated patients with CLD and thrombocytopenia; no significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.6; 95% C.I., 0.6-11.6; p=0.212). A significant difference was found for incidence of arterial and venous thrombo-embolic events in CLD patients treated with eltrombopag compared with placebo-treated patients (O.R.: 3.4; 95% C.I., 1.5-7.7; p=0.003). CONCLUSION The results of this meta-analysis show that TPORAs are not associated with PVT in CLD patients even in the case of surgical procedure. PVT risk seems to be associated only with eltrombopag use.