Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH

Lara N Roberts; Ton Lisman; Simon Stanworth; Virginia Hernandez-Gea; Maria Magnusson; Armando Tripodi; Jecko Thachil

doi:10.1111/jth.15562

Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH

J Thromb Haemost. 2022 Jan;20(1):39-47. doi: 10.1111/jth.15562. Epub 2021 Nov 8.

Authors

Lara N Roberts¹, Ton Lisman², Simon Stanworth^{3

4

5}, Virginia Hernandez-Gea⁶, Maria Magnusson^{7

8}, Armando Tripodi⁹, Jecko Thachil¹⁰

Affiliations

¹ King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital, London, UK.
² Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.
⁴ Department of Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK.
⁵ Radcliffe Department of Medicine, University of Oxford and NIHR Oxford Biomedical Research Centre (Haematology), Oxford, UK.
⁶ Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, IDIBAPS, Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), University of Barcelona, Barcelona, Spain.
⁷ Department of Pediatrics, Clinical Chemistry and Blood Coagulation Research, MMK, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
⁸ Department of Haematology, Karolinska University Hospital, Stockholm, Sweden.
⁹ IRCCS Ca' Granda Maggiore Hospital Foundation, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milano, Italy.
¹⁰ Department of Haematology, Manchester Royal Infirmary, Manchester, UK.

PMID: 34661370
DOI: 10.1111/jth.15562

Abstract

Prolonged prothrombin time and thrombocytopenia are common in patients with cirrhosis. These parameters do not reflect the overall hemostatic rebalance or bleeding risk in the periprocedural setting; however, attempts to correct these parameters remain frequent. We review the literature on periprocedural bleeding risk, bleeding risk factors, and the risk and benefits of hemostatic interventions in patients with cirrhosis. We provide guidance recommendations on evaluating bleeding risk in this patient group and management of hemostatic abnormalities in the periprocedural setting.

Keywords: cirrhosis; hemorrhage; hemostasis; liver diseases; thrombocytopenia.

Publication types

Review

MeSH terms

Blood Coagulation
Blood Coagulation Disorders* / etiology
Hemostasis
Humans
Liver Cirrhosis / complications
Liver Cirrhosis / diagnosis
Thrombocytopenia* / complications
Thrombocytopenia* / diagnosis
Thrombocytopenia* / therapy