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Current Gastroenterology Reports
Erschienen in: Current Gastroenterology Reports 9/2017

01.09.2017 | Liver (S Cotler and E Kallwitz, Section Editors)

Bleeding Risk with Invasive Procedures in Patients with Cirrhosis and Coagulopathy

verfasst von: Nekisa Zakeri, Emmanuel A. Tsochatzis

Erschienen in: Current Gastroenterology Reports | Ausgabe 9/2017

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Abstract

Purpose of Review

Previous perceptions of cirrhosis as a hypocoagulable state have resulted in empirical blood product transfusions prior to invasive procedures. We evaluate procedure-related bleeding risks in patients with cirrhosis, assess the utility of conventional and newer global coagulation tests, and explore evidence surrounding prophylactic transfusion strategies.

Recent Findings

Recent literature supports the concept of a rebalanced, albeit fragile, haemostasis equilibrium in cirrhosis, with a potential hypercoagulable tendency in stable patients. Standard coagulation tests provide a poor reflection of bleeding risks and yet are relied upon for transfusion thresholds. Consequently, a sizeable proportion of patients receive unnecessary blood products. The role of viscoelastic tests to guide transfusions requires further evaluation.

Summary

In stable cirrhotic patients, procedure-related bleeding rates appear low. Prophylactic transfusion strategies based on arbitrary thresholds lack evidence of clinical benefit. There is a pressing need for point-of-care coagulation tests that represent the complex coagulopathy of cirrhosis and well-powered randomised controlled trials to develop evidence-based pre-procedure transfusion guidelines.
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Metadaten
Titel
Bleeding Risk with Invasive Procedures in Patients with Cirrhosis and Coagulopathy
verfasst von
Nekisa Zakeri
Emmanuel A. Tsochatzis
Publikationsdatum
01.09.2017
Verlag
Springer US
Erschienen in
Current Gastroenterology Reports / Ausgabe 9/2017
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-017-0585-6

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