Abstract
Introduction
The concept of rebalanced hemostasis in cirrhosis challenges the policy of transfusing
plasma or platelets before invasive procedures in patients with prolonged PT or severe
thrombocytopenia. Recent guidelines recommend against plasma transfusion and suggest
avoiding/minimizing platelet transfusions.
Aim
We assessed how hepato-gastroenterologists manage prolonged PT/INR or severe thrombocytopenia
before invasive procedures.
Methods
On May 2021, AISF members were sent a questionnaire addressing the PT/INR and platelet
thresholds required before invasive procedures, the use of other markers of bleeding
risk or other hemostatic treatments and the burden of pre-emptive plasma and platelet
transfusions.
Results
Of 62 respondents, 94% and 100% use PT/INR and platelet count to assess bleeding risk,
respectively. Only 37% and 32% require less conservative PT/INR or platelet counts
thresholds for low-risk procedures, respectively. As for those applying single thresholds,
68% require PT/INR <1,5 and 86% require platelet counts ≥50 × 109/L. Half respondents use additional indicators of bleeding risk and 63% other hemostatic
treatments. Low-risk procedures account for 70% of procedures, and for 50% and 59%
of plasma and platelets units transfused, respectively.
Conclusions
the survey indicates lack of compliance with guidelines that advise against plasma
and platelet transfusions before invasive procedures and the need for prospective
studies and inter-society consensus workshops.
Keywords
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Article info
Publication history
Published online: April 23, 2022
Accepted:
March 25,
2022
Received:
December 13,
2021
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
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- Staging the pre-procedural prophylaxis in decompensated cirrhosisDigestive and Liver DiseaseVol. 54Issue 8
- PreviewWe read with interest the article by Tosetti et al, published recently in Digestive and Liver Disease [1]. By circulating a web survey within hepatologists and gastroenterologists affiliated with the Italian Association for the Study of the Liver (AISF), they investigated the current practice of pre-procedural prophylaxis in patients with cirrhosis in Italy. They found that: approximately all responders use INR and/or platelet count to predict bleeding risk; thresholds of INR to identify patients at risk vary significantly among centers; prophylaxis is commonly prescribed in patients with INR >1.5 and/or platelet count <50 × 109/L; low-risk procedures account for the majority of blood products transfusions, mostly fresh frozen plasma and platelets [1].
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