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

  • Domenico Alvaro
    Department of Translational and Precision Medicine Sapienza University of Rome Rome Italy
  • Nicola Caporaso
    Department of Clinical Medicine and Surgery University of Naples 'Federico II' Naples Italy
  • Edoardo Giovanni Giannini
    Gastroenterology Unit Department of Internal Medicine University of Genoa, IRCCS‐Ospedale Policlinico San Martino Genoa Italy
  • Angelo Iacobellis
    Division of Gastroenterology Fondazione IRCCS Casa Sollievo della Sofferenza Foggia Italy
  • Mariacristina Morelli
    IRCCS Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
  • Pierluigi Toniutto
    Hepatology and Liver Transplantation Unit Azienda Sanitaria Universitaria Integrata Academic Hospital Udine Italy
  • Francesco Violi
    I Clinica Medica Sapienza University of Rome Rome Italy

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Gaps of knowledge still exist about the potential association between severe thrombocytopenia and increased risk of procedure‐associated bleeding in patients with liver disease.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The literature search identified 1276 unique publications, and 15 studies met the inclusion criteria and were analysed together with those identified by the previous 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>

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