Bleeding after paracentesis in patients with decompensated cirrhosis and acute kidney injury: The perfect storm

Giannini, Edoardo G.; Bodini, Giorgia; Furnari, Manuele; Marabotto, Elisa

doi:10.1111/liv.13962

Cited by 1 publication

(1 citation statement)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This again shows that administration of plasma before procedures in patients with cirrhosis does not prevent bleeding, and is further consistent with studies demonstrating that plasma improves neither thrombin-generating capacity (46) nor stability of the clot. (47) This also suggests that the need and type of preprocedural prophylaxis depends not only on procedure risk (high vs. low risk procedures), but also on individual patient risk factors such as decompensation, infection, and AKI, (4,(43)(44)(45)48) which would warrant further testing such as TEG.…”

Section: Discussionmentioning

confidence: 99%

Reduced Clot Stability by Thromboelastography as a Potential Indicator of Procedure-Related Bleeding in Decompensated Cirrhosis

Zanetto

Rinder

Senzolo

et al. 2021

Hepatology Communications

View full text Add to dashboard Cite

In patients with decompensated cirrhosis, procedure-related bleeding is a potentially lethal complication. Routine coagulation tests such as international normalized ratio and platelet count do not predict bleeding risk. We investigated whether thromboelastography (TEG) can identify patients with cirrhosis who are at risk of procedure-related bleeding. As a part of a prospective study on hemostasis in decompensated cirrhosis, patients had TEG performed on admission and were followed prospectively during hospitalization for the development of procedure-related bleeding. Eighty patients with cirrhosis were included. Among the 72 who had procedures performed, 7 had procedure-related bleeding, which was major in three cases (two following paracentesis and one following thoracentesis). Conventional coagulation tests were comparable between bleeding and nonbleeding patients, whereas TEG parameters of k-time (4.5 minutes vs. 2.2 minutes; P = 0.02), α-angle (34° vs. 59°; P = 0.003), and maximum amplitude (37 mm vs. 50 mm; P = 0.004) were significantly different (all indicative of hypocoagulability). TEG maximum amplitude (MA), a marker of overall clot stability, accurately discriminated between patients who had major, life-threatening bleeding (all with MA < 30 mm) and those who had mild or no bleeding (all with MA > 30 mm), whereas a platelet count < 50 × 109/L could not discriminate between bleeding (minor or major) and nonbleeding patients. Conclusion: In a prospective cohort of hospitalized patients with decompensated cirrhosis, TEG parameters associated with hypocoagulability appeared to predict procedure-related bleeding, particularly a TEG MA < 30 mm. If results are validated in a larger cohort, this could be a threshold to identify patients with decompensated cirrhosis at higher risk for procedure-related bleeding, in whom to consider preprocedural prophylaxis.

show abstract