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:10.1007/s12664-015-0584-1

Cited by 34 publications

(28 citation statements)

References 27 publications

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“…Similarly, some prospective studies also showed that cirrhotic patients rarely developed major bleeding after invasive procedures and that the incidence of major bleeding after invasive procedures was 0%–2.3%. [ 10 11 22 ]…”

Section: Discussionmentioning

confidence: 99%

“…Coagulopathy was defined as INR ≥1.5 and/or PLT ≤50 × 10 9 /L. [ 11 13 20 ] Severe thrombocytopenia was defined as PLT ≤50 × 10 9 /L. [ 11 13 20 ] Major bleeding after invasive procedures was defined as overt bleeding or decrease in hemoglobin to less than 80 g/L after invasive procedures.…”

Section: Methodsmentioning

confidence: 99%

“…[ 11 13 20 ] Severe thrombocytopenia was defined as PLT ≤50 × 10 9 /L. [ 11 13 20 ] Major bleeding after invasive procedures was defined as overt bleeding or decrease in hemoglobin to less than 80 g/L after invasive procedures. [ 21 ] They were divided into patients with and without coagulopathy, patients with and without severe thrombocytopenia, and patients with INR ≥1.5 and INR <1.5.…”

Section: Methodsmentioning

confidence: 99%

“…also found that abnormal conventional coagulation parameters did not predict clinically significant bleeding in cirrhosis. [ 11 ] Tripodi et al . indicated no causal relationship between coagulopathy associated with chronic liver diseases and bleeding[ 5 ] and further suggested that PT and INR could reflect the severity of liver dysfunction and predict the mortality of acute and chronic liver diseases, but not the risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis

Han²,

et al. 2018

Saudi J Gastroenterol

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Background/Aim:Bleeding risk among patients with acute or chronic liver disease after invasive procedures is a common concern in clinical practice. This retrospective study aimed to explore whether the presence of coagulopathy increased the risk of major bleeding after invasive procedures in cirrhosis.Patients and Methods:A total of 874 cirrhotic patients underwent invasive procedures. Coagulopathy was defined as international normalized ratio (INR) ≥1.5 and/or platelets (PLTs) ≤50 × 109/L. Severe thrombocytopenia was defined as PLTs ≤ 50 × 109/L. Invasive procedures, major bleeding after invasive procedures, and in-hospital deaths were recorded.Results:In all, 296 patients (33.9%) had coagulopathy. Major bleeding after invasive procedures occurred in 21 patients (2.4%). Major bleeding after invasive procedures was more frequent in patients with coagulopathy than those without coagulopathy (4.1% vs 1.6%, P = 0.023). Major bleeding after invasive procedures was more frequent in patients with severe thrombocytopenia than those without severe thrombocytopenia (4.9% vs 1.6%, P = 0.008). Incidence of major bleeding after invasive procedures was not significantly different between patients with INR ≥ 1.5 and INR < 1.5 (4.5% vs 2.0%, P = 0.065). Patients with INR ≥1.5 had a significantly higher in-hospital mortality than those with INR < 1.5 (6.4% vs 1.3%, P < 0.001).Conclusion:Severe thrombocytopenia significantly increased the risk of major bleeding after invasive procedures in cirrhosis. INR ≥ 1.5 significantly increased in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis

Han²,

et al. 2018

Saudi J Gastroenterol

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“…[ 45 , 46 , 47 ] This results revealed the severity of the impairment and particularly the degree of neuromuscular inability of patients: thinking difficulties, problems with speaking fluently, guiding movements, memory alteration, and the appearance of tremors in their distal extremities. [ 4 , 6 , 48 , 49 , 50 , 51 ] In addition, H-R score with regards to genders showed that female patients in the study group were more psychologically and neurologically affected by HE when compared with male. [ 49 , 52 , 53 ]…”

Section: Discussionmentioning

confidence: 99%

Hepatic encephalopathy in patients in Lviv (Ukraine)

Djiambou-Nganjeu

2018

Journal of Translational Internal Medicine

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Background and ObjectivesHepatic encephalopathy (HE) research has long been impeded by the vague definition of this disabling complication of liver failure. This article provides an overview of the etiology and impact of HE on neuromuscular functions as well as its role in the development of infections and anemia.Materials and MethodsThis was a descriptive study conducted in 36 patients with HE. Close monitoring of these patients was done by checking on several parameters.ResultsThe etiological distribution: alcohol (67%), hepatitis C virus (HCV; 17%), HCV and alcohol (8%), hepatitis B virus (HBV; 3%), HBV and alcohol (3%), HBV and HCV (6%), and cryptogenic (3%). The laboratory results indicated an elevation of De Ritis level in 69% of cases and in 92% of total bilirubin values. The Halstead-Reitan (H-R) test score with regards to gender indicated that more than half of the patients had a score of 2, while only few cases received the scores 3 and 4. The frequency of H-R score with regards to Child-Pugh score showed the significant preponderance of Child-Pugh score of 7–9 (B): 58.3% compared to others groups of results, and these results indicated patients’ poor prognosis.ConclusionFindings showed the preponderance of female patients towards developing HE and the poor survival rate of patients older than 65 years. Alcohol and hepatitis C were the main causes associated with the development of HE. The neurological assessment marked the preponderance of Child-Pugh grades B and C and also the prevalence in female patients with neuropsychological disabilities through the assessment of H-R test.

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Plasma transfusions prior to insertion of central lines for people with abnormal coagulation

Hall

Estcourt

Dorée

et al. 2016

Cochrane Database of Systematic Reviews

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There is only very limited evidence from one RCT to inform the decision whether or not to administer prophylactic plasma prior to central venous catheterisation for people with abnormal coagulation. It is not possible from the current RCT evidence to recommend whether or not prophylactic plasma transfusion is beneficial or harmful in this situation. The three ongoing RCTs will not be able to answer this review's questions, because they are small studies and do not address all of the comparisons included in this review (355 participants in total). To detect an increase in the proportion of participants who had major bleeding from 1 in 100 to 2 in 100 would require a study containing at least 4634 participants (80% power, 5% significance).

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Coagulopathy in cirrhosis: A prospective study to correlate conventional tests of coagulation and bleeding following invasive procedures in cirrhotics

Abstract: Deranged conventional coagulation parameters did not predict clinically significant bleeding in cirrhosis. Whenever indicated, any invasive procedure could be safely carried out in patients with cirrhosis without prior correction of coagulation abnormalities.

Cited by 34 publications

References 27 publications

Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis

Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis

Hepatic encephalopathy in patients in Lviv (Ukraine)

Plasma transfusions prior to insertion of central lines for people with abnormal coagulation

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