A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation

Blasi, Annabel; Machlab, Salvador; Risco, Raquel; Costa-Freixas, Joao Pedro; Hernández-Cely, Geovanny; Horta, Diana; Bofill, Alex; Ruiz-Ramírez, Pablo; Profitós, J.; Sanahuja, Josep; Fernandez-Simon, Alejandro; Gómez, Mercedes Vergara; Sánchez-Delgado, Jordi; Cárdenas, Andrés

doi:10.1016/j.jhepr.2021.100363

Cited by 15 publications

(20 citation statements)

References 24 publications

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“…No differences in the frequency of post-EBL bleeding episodes were observed according to the previous administration of blood products. 186 A prospective randomised controlled trial evaluating the use of TEG to guide substitution of blood products in patients with cirrhosis undergoing elective procedures included 10 patients who underwent EBL, 6 were randomised to the TEG group while 4 received the standard of care. Although a sub-analysis in this subgroup was not done, in the whole study patients who were assigned to TEG received less blood products without differences in the frequency of bleeding episodes.…”

Section: Future Perspectivesmentioning

confidence: 99%

EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis

Villa¹,

Bianchini²,

Blasi³

et al. 2022

Journal of Hepatology

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177

135

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Section: Future Perspectivesmentioning

confidence: 99%

EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis

Villa¹,

Bianchini²,

Blasi³

et al. 2022

Journal of Hepatology

Self Cite

177

135

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“…Studies do not demonstrate a relationship between risk of bleeding and preendoscopic coagulation testing. [67][68][69][70] Rather, markers of disease severity and portal hypertension (model for end-stage liver disease and Child-Pugh score) may be more predictive of risk. Management is typically based on direct endoscopic measures for control and in some indications TIPS (transjugular intrahepatic portosystemic shunt).…”

Section: Reviewmentioning

confidence: 99%

“…A recent multicentre study demonstrated that administering platelets or FFP prior to endoscopic band ligation did not reduce bleeding. 70 The role of measures to support the haemostatic system in active severe bleeding remain unstudied and empirical individualised approaches are recommended.…”

Section: Reviewmentioning

confidence: 99%

Haemostatic alterations and management of haemostasis in patients with cirrhosis

Lisman

Caldwell

Intagliata

2022

Journal of Hepatology

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“…There is also a lot of scepticism associated with FFP transfusion in these patients based on the results of the retrospective study of 244 patients by Mohanty et al [ 11 ] which reported more severe episodes of bleeding along with higher rebleed rates at day 5, longer hospital stay and higher mortality at 42 d among 100 patients with AVB who received FFP. Even for patients undergoing prophylactic EVL of varices, higher rates of post EVL bleed were associated with advanced liver disease and not baseline INR or platelets as reported by Blasi et al [ 33 ] Thus baseline thrombocytopenia or deranged INR do not lead to higher post EVL bleeding rates in a prophylactic or emergent setting and attempting to correct it with transfusions may lead to more harm than good.…”

Section: Discussionmentioning

confidence: 81%

Effect of thrombocytopenia and platelet transfusion on outcomes of acute variceal bleeding in patients with chronic liver disease

Biswas¹,

Vaishnav²,

Pathak³

et al. 2022

WJH

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BACKGROUND Platelet transfusion in acute variceal bleeding (AVB) is recommended by few guidelines and is common in routine clinical practice, even though the effect of thrombocytopenia and platelet transfusion on the outcomes of AVB is unclear. AIM To determine how platelet counts, platelets transfusions, and fresh frozen plasma transfusions affect the outcomes of AVB in cirrhosis patients in terms of bleeding control, rebleeding, and mortality. METHODS Prospectively maintained database was used to analyze the outcomes of cirrhosis patients who presented with AVB. The outcomes were assessed as the risk of rebleeding at days 5 and 42, and risk of death at day 42, considering the platelet counts and platelet transfusion. Propensity score matching (PSM) was used to compare the outcomes in those who received platelet transfusion. Statistical comparisons were done using Kaplan-Meier curves with log-rank tests and Cox-proportional hazard model for rebleeding and for 42-d mortality. RESULTS The study included 913 patients, with 83.5% men, median age 45 years, and Model for End-stage Liver Disease score 14.7. Platelet count < 20 × 10 9 /L, 20-50 × 10 9 /L, and > 50 × 10 9 /L were found in 23 (2.5%), 168 (18.4%), and 722 (79.1%) patients, respectively. Rebleeding rates were similar between the three platelet groups on days 5 and 42 (13%, 6.5%, and 4.7%, respectively, on days 5, P = 0.150; and 21.7%, 17.3%, and 14.4%, respectively, on days 42, P = 0.433). At day 42, the mortality rates for the three platelet groups were also similar (13.0%, 23.2%, and 17.2%, respectively, P = 0.153). On PSM analysis patients receiving platelets transfusions ( n = 89) had significantly higher rebleeding rates on day 5 (14.6% vs 4.5%; P = 0.039) and day 42 (32.6% vs 15.7%; P = 0.014), compared to those who didn't. The mortality rates were also higher among patients receiving platelets (25.8% vs 23.6%; P = 0.862), although the difference was not significant. On multivariate analysis, platelet transfusion and not platelet count, was independently associated with 42-d rebleeding. Hepatic encephalopathy was independently associated with 42-d mortality. CONCLUSION Thrombocytopenia had no effect on rebleeding rates or mortality in cirrhosis patients with AVB; however, platelet transfusion increased rebleeding on days 5 and 42, with a higher but non-significant effect on mortality.

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A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation

Abstract: analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation,

Cited by 15 publications

References 24 publications

EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis

EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis

Haemostatic alterations and management of haemostasis in patients with cirrhosis

Effect of thrombocytopenia and platelet transfusion on outcomes of acute variceal bleeding in patients with chronic liver disease

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