Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines

Biolato, Marco; Vitale, Federica; Galasso, Tiziano; Gasbarrini, Antonio; Grieco, Antonio

doi:10.4240/wjgs.v15.i2.127

Cited by 7 publications

(1 citation statement)

References 126 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings, which suggest heightened bleeding risks in patients with platelet counts below this threshold, are consistent with these guidelines. The American Society for Gastrointestinal Endoscopy (ASGE), however, indicates that there is no established minimum threshold for diagnostic upper GI endoscopy, with some authors suggesting 20,000/mL as a safe lower limit [9][10][11]. The disparity in these recommendations highlights the need for a personalized approach, considering individual patient risks and the nature of the procedure.…”

Section: Discussionmentioning

confidence: 99%

The Safety of Endoscopic Procedures in Patients With Thrombocytopenia: A Systematic Review and Meta-Analysis

Patel,

Treves,

Samreen

2024

Cureus

View full text Add to dashboard Cite

Endoscopic procedures are essential in gastroenterology but pose significant risks for thrombocytopenic patients who have lower platelet counts, increasing the likelihood of bleeding complications. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess bleeding risks in thrombocytopenic patients undergoing various endoscopic procedures. A comprehensive search was conducted across databases like PubMed, MEDLINE, and EBSCO, using stringent criteria for inclusion and exclusion, with study quality assessed via the Newcastle-Ottawa Scale and thrombocytopenia severity classified by Common Terminology Criteria for Adverse Events (CTCAE) criteria. Statistical analysis focused on bleeding event incidence rates at different platelet count thresholds, utilizing RevMan Web (Cochrane, London, UK) and Excel (Microsoft® Corp., Redmond, WA). The search yielded 1,675 potential articles, but only three retrospective cohort studies were selected. Results showed a significant increase in bleeding risk for patients with platelet counts below 50,000/mm 3 , particularly under 25,000/mm 3 , with a 5.5% prevalence of post-procedure bleeding in moderate to severe thrombocytopenic patients versus 4.0% in those with higher counts, and a threefold higher risk in severe thrombocytopenia. The study highlights the need for meticulous pre-procedure assessments in thrombocytopenic patients and points out disparities in guideline recommendations, suggesting personalized approaches based on patient-specific risks. It underscores balancing diagnostic yield against bleeding risks, especially in severe thrombocytopenia, and discusses the controversial role of prophylactic platelet transfusions, advocating for a nuanced approach. In conclusion, this meta-analysis provides critical insights into managing thrombocytopenia in endoscopic procedures, emphasizing the importance of individualized patient assessment and adherence to evolving guidelines, and underlining the necessity of further research to refine these guidelines and improve patient safety and outcomes in this challenging clinical scenario.

show abstract

Section: Discussionmentioning

confidence: 99%

The Safety of Endoscopic Procedures in Patients With Thrombocytopenia: A Systematic Review and Meta-Analysis

Patel,

Treves,

Samreen

2024

Cureus

View full text Add to dashboard Cite

show abstract

Avatrombopag Elevates Platelet Counts and Reduces Platelet Transfusions in Patients With Chronic Liver Diseases During the Perioperative Period of Liver Transplantation

Jia,

Zhang,

Chen

et al. 2024

Organ Medicine

View full text Add to dashboard Cite

BackgroundAvatrombopag has been approved for elevating platelet counts in patients with chronic liver diseases (CLDs) accompanied by thrombocytopenia (TCP). However, limited research focuses on its safety and efficacy in CLD patients during the perioperative period of liver transplantation (LT).MethodsWe retrospectively enrolled CLD patients with severe TCP who received avatrombopag during the perioperative period of LT and analyzed therapeutic efficacy, changes in platelet counts, and related adverse events. Comparisons were conducted between liver transplant recipients who received avatrombopag and those who did not use platelet‐raising drugs, focusing on intraoperative and postoperative bleeding as well as platelet transfusions.ResultsOf 93 patients who received avatrombopag, 67 cases (72%) achieved remission, with their platelet counts increasing to over 50 × 109/L without transfusion. Additionally, 38 cases (40.9%) reached platelet counts above 100 × 109/L, achieving complete remission. The overall remission rate was significantly correlated with the baseline platelet counts, suggesting that individuals with higher baselines (25−50 × 109/L vs. < 25 × 109/L) were more likely to achieve remission (82.1% vs. 57.7%, χ2 = 5.989, p = 0.014). Using propensity score‐overlap weighting to balance the baseline bias, we compared 33 liver transplant recipients who received avatrombopag to those who did not receive any platelet‐raising drugs. Recipients who used avatrombopag achieved significantly higher platelet counts both before and after propensity score‐overlap weighting ([63.76 ± 31.33] × 109/L vs. [45.73 ± 16.44] × 109/L, p = 0.004; [65.37 ± 38.41] × 109/L vs. [42.73 ± 17.27] × 109/L, p = 0.044) and required fewer intraoperative and postoperative platelet transfusions (p < 0.05). No adverse events related to avatrombopag were observed.ConclusionsAvatrombopag is safe and effective for CLD patients with TCP during the perioperative period of LT, resulting in elevated platelet counts and reduced need for platelet transfusions.

show abstract

Comparison of laser and traditional lancing devices for capillary blood sampling in patients with diabetes mellitus and high bleeding risk

Park,

Hwang,

Jang

et al. 2024

Lasers Med Sci

View full text Add to dashboard Cite

Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines

Cited by 7 publications

References 126 publications

The Safety of Endoscopic Procedures in Patients With Thrombocytopenia: A Systematic Review and Meta-Analysis

The Safety of Endoscopic Procedures in Patients With Thrombocytopenia: A Systematic Review and Meta-Analysis

Avatrombopag Elevates Platelet Counts and Reduces Platelet Transfusions in Patients With Chronic Liver Diseases During the Perioperative Period of Liver Transplantation

Comparison of laser and traditional lancing devices for capillary blood sampling in patients with diabetes mellitus and high bleeding risk

Contact Info

Product

Resources

About