Bleeding time in patients with hepatic cirrhosis.

Blake, J C; Sprengers, Dave; Grech, P; McCormick, PA; McIntyre, N; Burroughs, A K

doi:10.1136/bmj.301.6742.12

Cited by 63 publications

(22 citation statements)

References 17 publications

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“…3 Malnutrition, impaired immunity, coagulopathy and metabolic bone disease often develop in patients with cirrhosis of the liver. [4][5][6][7][8] Such changes may adversely affect the outcome if these patients require major orthopaedic surgery, such as total hip arthroplasty (THA).…”

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confidence: 99%

Hip arthroplasty in patients with cirrhosis of the liver

Hsieh

Chen

Lee

et al. 2003

The Journal of Bone and Joint Surgery. British volume

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e retrospectively reviewed 45 hip arthroplasties which were performed over a period of 20 years in 38 patients with cirrhosis of the liver. There was a high perioperative 30-day complication rate (26.7%). Advanced cirrhosis was associated with a higher risk of complications (p = 0.004) as also was increased age, a high level of creatinine, a low level of albumin, a low platelet count, ascites, encephalopathy and an increased operative blood loss. The survival of the prosthesis at five years was 77.8% and infection was a major cause of failure.In view of the high rate of early complications and the limited longevity of the prosthesis, surgeons who perform hip arthroplasty on such patients should counsel them appropriately preoperatively.

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confidence: 99%

Hip arthroplasty in patients with cirrhosis of the liver

Hsieh

Chen

Lee

et al. 2003

The Journal of Bone and Joint Surgery. British volume

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“…Bleeding time has demonstrated some utility in predicting bleeding risk associated with liver biopsy: bleeding events after percutaneous liver biopsy were more frequent in a subset of patients with prolonged bleeding time as determined by the Ivy-Template method in one uncontrolled study in which platelet count was over 60×103/dL and PT was less than 16 s [84]. However, to draw a definite conclusion, many hundreds of patients would have to be studied without measures to improve primary hemostasis and less invasive procedures for liver biopsy (i.e., transjugular liver biopsy) would have to be used alternatively, and this could be of ethical concern [85]. In actual clinical practice, bleeding time is not routinely performed before liver biopsy in cirrhosis, being cumbersome, partly reflecting platelet count, and of unclear value in predicting bleeding.…”

Section: Bleeding During Invasive Proceduresmentioning

confidence: 99%

Assessment of Bleeding Risk in Patients with Cirrhosis

Zanetto

Senzolo

Ferrarese

et al. 2015

Curr Hepatology Rep

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Cirrhosis is characterized by varying degrees of alterations of the different components of hemostasis, including thrombocytopenia, reduction of procoagulant factors, overactivation of the fibrinolytic system, and a precarious hemostatic equilibrium that can easily tilt towards bleeding. Predicting the risk of spontaneous bleeding from nonvariceal sites, variceal bleeding, and hemorrhagic complications associated with surgery or invasive procedures is a formidable challenge faced by clinicians caring for cirrhosis patients, and standard assays have demonstrated a poor correlation with episodes of bleeding. While new tests evaluating different components of coagulation as well as global assays are increasingly available and used to guide therapeutic approaches, there is still no optimal method to assess bleeding risk, and a combination between severity of liver disease, the presence of ongoing infection or renal insufficiency, as well as the type of bleeding itself seems to still be very important in evaluating the individual patient's risk.

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“…Blake et al [121] advocated evaluating the use of bleeding time to assess the risk of bleeding for percutaneous liver biopsy, but this is not carried out in clinical practice. If clotting parameters are outside stipulated ranges, a transjugular liver biopsy can be more safely performed, without plasma or platelet therapy [122].…”

Section: Invasive Proceduresmentioning

confidence: 99%