Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study

Acquired bleeding disorders

“…A large meta‐analysis has demonstrated that a pre‐procedural international normalised ratio (INR) has no relation to post‐procedural bleeding risk 36 . Whether a low platelet count predicts procedural bleeding has been debated in literature, but a recent large prospective observational study demonstrated that haemostasis tests including the platelet count do not predict procedural bleeding 37 …”

“…This perception is likely driven by the abnormalities in routine diagnostic haemostasis tests. A recent prospective observational study documenting bleeding in > 3000 procedures demonstrated that major bleeding defined by the International Society of Thrombosis and Haemostasis (ISTH) definitions for major bleeding was only .9% 37 . Spontaneous bleeding in patients with cirrhosis is uncommon, and when it occurs, bleeds are minor (bruising, nose and gum bleeds, menorrhagia) and generally require no interventions.…”

A British Society for Haematology guideline on the assessment and management of bleeding risk prior to invasive procedures

“…110 A large prospective multicentre observational study of procedural bleeding in 1187 hospitalised patients with decompensated cirrhosis or ACLF undergoing 3006 procedures reported an overall low incidence of major bleeding (0.9% of procedures). 111 No relationship was identified between INR, platelet count and procedural bleeding. Independent predictors of bleeding were high bleeding risk procedures (OR 4.6, 95% CI: 2.4-8.4), liver disease severity (evaluated with model for endstage liver disease OR 2.37, 95% CI: 1.5-3.9) and body mass index (OR 1.4, 95% CI: 1.1-1.8).…”

“…Age Risk factor for cardiac surgery and renal biopsy 161,166 High-risk procedures should be undertaken or assisted by an experienced operator, if patient of an advanced age Hypertension Systolic >160 mmHg Diastolic >100 mmHg MAP >120 mmHg Increased risk of postrenal biopsy bleeding 111,162 Evidence suggests surgical procedures should not be delayed but hypertension treated >180/110 with antihypertensive medications 167 Seek history of hypertension Experienced operator Enhanced postoperative monitoring Consider oral antihypertensive agent High serum creatinine Marker of a higher risk procedure-with increased risk of bleeding postrenal biopsy >177 μmol/L, 168 and thoracentesis >520 μmol/L 96 Correlation between renal disease and paracentesis haemorrhagic risk 158 Experienced operator Enhanced postoperative monitoring Obesity Increased risk of failure of landmark-based intervention; lumbar puncture 158,165 Image guidance; fluoroscopy/ultrasound Red cell volume/haematocrit Preoperative anaemia or small body size is a risk factor for blood transfusion in cardiac surgery 166 Experienced operator Enhanced postoperative monitoring Infection Increases the risk of bleeding in patients with acute-on-chronic liver failure 90 Treat infection Abbreviations: MAP, mean arterial pressure; RCT, randomised controlled trial.…”

Bioinformatics‐based analysis of the relationship between plasminogen regulatory genes and photoaging

“…We use the pROC package to produce the ROC curve of hub genes and different groups and calculate the area under the curve (AUC) to evaluate the diagnostic effect of hub genes expression on photoaging. 14 Hub gene expression profiles of photoaging and control samples in the validation dataset were acquired, and t-tests were used to compare the genetic expression levels of key genes between photoaging and normal samples.…”