<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Abstract

Thrombocytopenia is a frequent complication in patients with cirrhosis. As many as 84% of patients with cirrhosis have thrombocytopenia, and it is an independent variable indicative of advanced disease and poor prognosis. Although there is great concern that it may aggravate bleeding during surgical procedures, there is limited evidence to inform decisions regarding the treatment of cirrhotic patients with thrombocytopenia undergoing invasive procedures. Finally, there is evidence that platelets play a significant role in liver regeneration. In this report, the clinical implications of thrombocytopenia in cirrhotic patients are reviewed. The utility of platelet counts in the prognosis of cirrhosis and relationship to complications of advanced liver disease, including portal hypertension, esophageal varices, and hepatocellular carcinoma. The impact of low platelet counts on bleeding complications during invasive procedures is outlined. Finally, the role of platelets and potential adverse impact in liver regeneration is reviewed.

Longitudinal decrease in platelet counts as a surrogate marker of liver fibrosis

“…Thrombocytopenia (platelet count < 150000/μL) is one of the most common abnormalities in patients with cirrhosis, seen in up to 78% of cirrhotic patients[ 5 ]. Thrombocytopenia carries important prognostic information in terms of the presence of cirrhosis, portal hypertensive complications, hepatocellular carcinoma, post-liver resection and the post-transplant course[ 6 ]. Indeed, there is a correlation between the degree of thrombocytopenia and the stage and severity of liver disease; severe thrombocytopenia (< 50000/μL) is a poor prognostic factor associated with significant morbidity, indicating an advanced liver disease with established portal HTN[ 7 , 8 ].…”

Assessing the periprocedural magnitude of platelet count change in response to lusutrombopag

“…Patients with thrombocytopaenia associated with chronic liver disease (TCP-CLD) are at risk for both thrombotic and haemorrhagic complications given the complex, altered balance between thrombosis and bleeding in this patient population. [1][2][3] TCP is a reflection of the severity of CLD and contributes to the potential increased risk of bleeding in CLD patients in conjunction with the interplay between multiple elements in the haemostatic system such as platelet dysfunction, anti-platelet antibodies, platelet sequestration and destruction related to hypersplenism, myelosuppression, and alterations in haematopoietic and coagulation factors. [1][2][3] For example, the risk of bleeding in CLD may be affected by decreased thrombin production when platelet counts fall below approximately 50 × 10 9 /L, 4 yet this is countered by an increase in von Willebrand factor.…”

“…[1][2][3] TCP is a reflection of the severity of CLD and contributes to the potential increased risk of bleeding in CLD patients in conjunction with the interplay between multiple elements in the haemostatic system such as platelet dysfunction, anti-platelet antibodies, platelet sequestration and destruction related to hypersplenism, myelosuppression, and alterations in haematopoietic and coagulation factors. [1][2][3] For example, the risk of bleeding in CLD may be affected by decreased thrombin production when platelet counts fall below approximately 50 × 10 9 /L, 4 yet this is countered by an increase in von Willebrand factor. 1,2 Notwithstanding, TCP influences clinical decisions in CLD patients, in particular when weighing the risks vs. benefits of certain diagnostic or therapeutic interventions.…”

“…[1][2][3] For example, the risk of bleeding in CLD may be affected by decreased thrombin production when platelet counts fall below approximately 50 × 10 9 /L, 4 yet this is countered by an increase in von Willebrand factor. 1,2 Notwithstanding, TCP influences clinical decisions in CLD patients, in particular when weighing the risks vs. benefits of certain diagnostic or therapeutic interventions. [1][2][3] Most clinicians and society guidelines recommend that a patient has a platelet count > − 50 × 10 9 /L before an invasive procedure.…”

“…1,2 Notwithstanding, TCP influences clinical decisions in CLD patients, in particular when weighing the risks vs. benefits of certain diagnostic or therapeutic interventions. [1][2][3] Most clinicians and society guidelines recommend that a patient has a platelet count > − 50 × 10 9 /L before an invasive procedure. [5][6][7][8][9][10][11] Platelet transfusion has been the standard of care to reduce the risk of bleeding in patients with TCP-CLD undergoing invasive procedures.…”