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Semin Liver Dis 2018; 38(03): 215-229
DOI: 10.1055/s-0038-1660523
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

Filippo Schepis
1   Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
,
Laura Turco
1   Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
,
Marcello Bianchini
1   Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
,
Erica Villa
1   Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
24 July 2018 (online)

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Abstract

Cirrhosis represents the end stage of chronic liver disease and its transition from a compensated to a decompensated status is mainly driven by portal hypertension and systemic inflammation. Although relevant modifications in the evaluation of the coagulative balance in cirrhosis across its natural history have occurred and alterations in routine indices of hemostasis have lost their role as indicators of the hemorrhagic risk of patients with liver cirrhosis, these are still perceived as prone to bleed when admitted to invasive procedures. This view, which is still present in guidelines addressing the management of bleeding risk, makes preprocedural transfusion of plasma and platelets still an ongoing clinical practice. In this review, we describe the limitations of both bleeding risk assessment in cirrhotic patients admitted to radiologic and endoscopic invasive procedures and evaluate whether preventive strategies indicated by current guidelines can affect the procedure-related hemorrhagic events.

Keywords

viscoelastic tests - acute on chronic liver failure - coagulopathy - decompensation
 

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