Coagulopathy in Cirrhosis: A Prospective Study to Correlate Conventional Tests of Coagulation and Bleeding Following Invasive Procedures in Cirrhotics

Shah, Apurva; Amarapurkar, Deepak; Dharod, Mrudul; Chandnani, Madhuri; Baijal, Rajiv; Kumar, Praveen; Jain, Mayank; Patel, N.; Kamani, Praful; Gautam, Sonali; Shah, Nimish; Kulkarni, Sandeep; Doshi, Soham

doi:10.1016/j.cgh.2015.04.123

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…In another study, Indian patients with cirrhosis (n=380) were assessed prospectively according to the presence or absence of abnormal coagulation parameters (defined as INR ≥1.5 and/or platelet count ≤50 000/μL). These deranged conventional coagulation parameters did not predict clinically significant bleeding in cirrhosis and both high‐ and low‐risk invasive procedures were carried out safely …”

Section: Risk Of Thrombocytopenia With Proceduresmentioning

confidence: 92%

“…These deranged conventional coagulation parameters did not predict clinically significant bleeding in cirrhosis and both high-and low-risk invasive procedures were carried out safely. 16 Therapeutic procedures (but not diagnostic procedures with lower gauge needles) in cirrhotic patients may lead to mild bleeding complications, which are dependent upon the characteristics of the patient (e.g. higher risk with platelet count [≤50 000/μL], Child-Pugh stage C and alcoholic cirrhosis) and of the procedure itself.…”

Section: Invasive Proceduresmentioning

confidence: 99%

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Thrombocytopenia in chronic liver disease

Peck‐Radosavljevic

2016

Liver International

217

180

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Thrombocytopenia is a common haematological disorder in patients with chronic liver disease. It is multifactorial and severity of liver disease is the most influential factor. As a result of the increased risk of bleeding, thrombocytopenia may impact upon medical procedures, such as surgery or liver biopsy. The pathophysiology of thrombocytopenia in chronic liver disease has long been associated with the hypothesis of hypersplenism, where portal hypertension causes pooling and sequestration of all corpuscular elements of the blood, predominantly thrombocytes, in the enlarged and congested spleen. Other mechanisms of importance include bone marrow suppression by toxic substances, such as alcohol or viral infection, and immunological removal of platelets from the circulation. However, insufficient platelet recovery after relief of portal hypertension by shunt procedures or minor and transient recovery after splenic artery embolization have caused many to question the importance and relative contribution of this mechanism to thrombocytopenia. The discovery of the cytokine thrombopoietin has led to the elucidation of a central mechanism. Thrombopoietin is predominantly produced by the liver and is reduced when liver cell mass is severely damaged. This leads to reduced thrombopoiesis in the bone marrow and consequently to thrombocytopenia in the peripheral blood of patients with advanced-stage liver disease. Restoration of adequate thrombopoietin production post-liver transplantation leads to prompt restoration of platelet production. A number of new treatments that substitute thrombopoietin activity are available or in development.

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Section: Risk Of Thrombocytopenia With Proceduresmentioning

confidence: 92%

Section: Invasive Proceduresmentioning

confidence: 99%

Thrombocytopenia in chronic liver disease

Peck‐Radosavljevic

2016

Liver International

217

180

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“…Assessment of bleeding risk in CH is challenging because of the liver's complex and antagonistic role in the synthesis and degradation of pro‐ and anti‐thrombotic proteins and its role in fibrinolysis . Assessment by evaluation of prothrombin time (PT), activated partial thromboplastin time (aPTT), plasma fibrinogen concentration, platelet count, or buccal mucosal bleeding time (BMBT) does not consistently predict risk of bleeding after liver biopsy in humans . In humans, there is consensus that moderate to severe prolongations in PT and aPTT (>1.5 × upper limit of normal), platelet count <50 000/μL, anemia (PCV < 30%), and low plasma fibrinogen concentration (<100 mg/dL) have some predictive ability in assessing bleeding risk and thus these variables have been incorporated into pre‐procedural standard of care guidelines …”

Section: Biopsy Acquisitionmentioning

confidence: 99%

“…214,[230][231][232][233] Assessment by evaluation of prothrombin time (PT), activated partial thromboplastin time (aPTT), plasma fibrinogen concentration, platelet count, or buccal mucosal bleeding time (BMBT) does not consistently predict risk of bleeding after liver biopsy in humans. [234][235][236][237] In humans, there is consensus that moderate to severe prolongations in PT and aPTT (>1.5 × upper limit of normal), platelet count <50 000/μL, anemia (PCV < 30%), and low plasma fibrinogen concentration (<100 mg/dL) have some predictive ability in assessing bleeding risk and thus these variables have been incorporated into pre-procedural standard of care guidelines. [237][238][239][240] Coagulation and hematological abnormalities may exist in dogs with CH.…”

Section: Pre-biopsy Considerationsmentioning

confidence: 99%

ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs

Webster

Cullen

Penninck

et al. 2019

Veterinary Internal Medicne

198

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This consensus statement on chronic hepatitis (CH) in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs. It was generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH, the Veterinary Information Network for abstracts and conference proceeding from annual meetings of the American College of Veterinary Medicine and the European College of Veterinary Medicine, and selected manuscripts from the human literature on CH. The panel recognizes that the diagnosis and treatment of CH in the dog is a complex process that requires integration of clinical presentation with clinical pathology, diagnostic imaging, and hepatic biopsy. Essential to this process is an index of suspicion for CH, knowledge of how to best collect tissue samples, access to a pathologist with experience in assessing hepatic histopathology, knowledge of reasonable medical interventions, and a strategy for monitoring treatment response and complications.

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“…Whenever indicated, any invasive procedures could be safely carried out in patients with cirrhosis without past correction of abnormal routine coagulation tests. (3) In the preliminary data of an ongoing prospective study of 60 patients with cirrhosis who underwent invasive procedures, we compared TEG with conventional coagulation tests in all patients; none of the patients in the study received prophylactic correction of abnormal conventional coagulation tests before the invasive procedure or surgery. We found that only 1 patient developed postprocedural clinically significant bleeding.…”

mentioning

confidence: 99%