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Preprocedural prophylaxis with blood products in patients with cirrhosis: Results from a survey of the Italian Association for the Study of the Liver (AISF)

  • G. Tosetti
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
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  • E. Farina
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
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  • R. Caccia
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
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  • A. Sorge
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
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  • A. Berzuini
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Transfusion Medicine and Hematology
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  • L. Valenti
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Transfusion Medicine and Hematology
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  • D. Prati
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Transfusion Medicine and Hematology
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  • A. Tripodi
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy
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  • P. Lampertico
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy

    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Transfusion Medicine and Hematology

    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy

    CRC “A. M. and A. Migliavacca” Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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  • M. Primignani
    Correspondence
    Corresponding author.
    Affiliations
    Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
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Published:April 23, 2022DOI:https://doi.org/10.1016/j.dld.2022.03.017

      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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      Linked Article

      • Staging the pre-procedural prophylaxis in decompensated cirrhosis
        Digestive and Liver DiseaseVol. 54Issue 8
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          We 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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