Bleeding after invasive procedures is rare and unpredicted by platelet counts in cirrhotic patients with thrombocytopenia

被引:97
作者
Napolitano, Grazia [1 ]
Iacobellis, Angelo [1 ]
Merla, Antonio [1 ]
Niro, Grazia [1 ]
Valvano, Maria Rosa [1 ]
Terracciano, Fulvia [1 ]
Siena, Domenico [1 ]
Caruso, Mariangela [1 ]
Ippolito, Antonio [1 ]
Mannuccio, Pier Mannucci [2 ,3 ]
Andriulli, Angelo [1 ]
机构
[1] Casa Sollievo Sofferenza Hosp, IRCCS, Div Gastroenterol, Viale Cappuccini 1, I-71013 San Giovanni Rotondo, Italy
[2] Policlin Maggiore Hosp Fdn, IRCCS Ca Granda, Angelo Bianchi Bonomi Hemophilia & Thrombosis Ctr, Milan, Italy
[3] Univ Milan, Milan, Italy
关键词
Cirrhosis; Liver cirrhosis; Bleeding; Hemorrhage; Platelets; Coagulation; LIVER; ABNORMALITIES; TRANSFUSION; PROPHYLAXIS; GUIDELINES;
D O I
10.1016/j.ejim.2016.11.007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: In cirrhotics with low circulating platelets (PLT), restoration of normal cell counts has been traditionally recommended before invasive procedures. However, there is neither consensus on the PLT transfusion threshold nor evidence of its clinical efficacy. Patients: In order to fill this gap of knowledge, we prospectively collected and analyzed data on circulating PLT counts [ and International Normalized Ratio (INR)] values in a case series of 363 cirrhotics scheduled to undergo invasive investigations. PLT and/or fresh-frozen plasma(FFP) unitswere infused at the discretion of the attending physician, and the occurrence of post-procedural bleeding was related to pre-and post-infusion results. Results: 852 Procedures were carried out in 363 cirrhotics sub-grouped according to the Child-Pugh-Turcotte (CPT) classification (class A/B/C: 124/154/85). The infusion of PLT and/or FFP improved only marginally circulating PLT counts and INR values. Ten post-procedural bleeds occurred in the whole case series, i.e. 1 episode every 85 procedures or every 36 patients. Post-procedural bleeding was unrelated to the PLT counts, to the degree of INR abnormalities, nor to the CPT classes, but was more frequent in patients who underwent repeated investigations. In the 10 patients with the most profound alterations in PLT and/or INR values, no post-procedural bleeding occurred. Conclusions: In cirrhotic patients with low PLT and/or abnormal INR values undergoing invasive investigations, post-procedural bleeding was rare and unpredicted by PLT counts or abnormal INR values. In particular, the recommendation to infuse platelets when counts are < 50 x 10(3)/L is not substantiated by this case series of cirrhotic patients. (C) 2016 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
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收藏
页码:79 / 82
页数:4
相关论文
共 22 条
[1]   Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference [J].
Andriulli, Angelo ;
Tripodi, Armando ;
Angeli, Paolo ;
Senzolo, Marco ;
Primignani, Massimo ;
Giannini, Edoardo G. ;
Riggio, Oliviero ;
Colli, Agostino ;
Prati, Daniele ;
Sacerdoti, David ;
Merkel, Carlo ;
Basili, Stefania ;
Ferro, Domenico ;
Villa, Erica ;
Di Minno, Giovanni ;
Caraceni, Paolo ;
Marzioni, Marco ;
Mannucci, Pier Mannuccio ;
Violi, Francesco .
DIGESTIVE AND LIVER DISEASE, 2016, 48 (05) :455-467
[2]   Measuring bleeding as an outcome in clinical trials of prophylactic platelet transfusions [J].
Bercovitz, Rachel S. ;
O'Brien, Sarah H. .
HEMATOLOGY-AMERICAN SOCIETY OF HEMATOLOGY EDUCATION PROGRAM, 2012, :157-160
[3]   Guidelines for the transfusion of platelets [J].
Bosly, A. ;
Muylle, L. ;
Noens, L. ;
Pietersz, R. ;
Heim, D. ;
Hubner, R. ;
Selleslag, D. ;
Toungouz, M. ;
Ferrant, A. ;
Sondag, D. .
ACTA CLINICA BELGICA, 2007, 62 (01) :36-47
[4]  
CATURELLI E, 1993, LIVER, V13, P270
[5]   How conservative is Fisher's exact test? A quantitative evaluation of the two-sample comparative binomial trial [J].
Crans, Gerald G. ;
Shuster, Jonathan J. .
STATISTICS IN MEDICINE, 2008, 27 (18) :3598-3611
[6]  
DELLINGER RP, 2013, INTENS CARE MED, V39, P165, DOI DOI 10.1007/s00134-012-2769-8
[7]   Large-bore Tunneled Central Venous Catheter Insertion in Patients with Coagulopathy [J].
Haas, Brian ;
Chittams, Jesse L. ;
Trerotola, Scott O. .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 2010, 21 (02) :212-217
[8]   Platelet Transfusion: A Clinical Practice Guideline From the AABB [J].
Kaufman, Richard M. ;
Djulbegovic, Benjamin ;
Gernsheimer, Terry ;
Kleinman, Steven ;
Tinmouth, Alan T. ;
Capocelli, Kelley E. ;
Cipolle, Mark D. ;
Cohn, Claudia S. ;
Fung, Mark K. ;
Grossman, Brenda J. ;
Mintz, Paul D. ;
O'Malley, Barbara A. ;
Sesok-Pizzini, Deborah A. ;
Shander, Aryeh ;
Stack, Gary E. ;
Webert, Kathryn E. ;
Weinstein, Robert ;
Welch, Babu G. ;
Whitman, Glenn J. ;
Wong, Edward C. ;
Tobian, Aaron A. R. .
ANNALS OF INTERNAL MEDICINE, 2015, 162 (03) :205-U118
[9]  
Kelsey P, 2003, BRIT J HAEMATOL, V122, P10
[10]   Pharmacologic prophylaxis against venous thromboembolism in hospitalized patients with cirrhosis and associated coagulopathies [J].
Koliscak, Lindsey ;
Maynor, Lena .
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2012, 69 (08) :658-663