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

Filippo Schepis; Laura Turco; Marcello Bianchini; Erica Villa

doi:10.1055/s-0038-1660523

Seminars in Liver Disease, Table of Contents

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

¹Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

,

Laura Turco

¹Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

,

Marcello Bianchini

¹Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

,

Erica Villa

¹Gastroenterology Unit, Department of Medical Specialties, Università degli Studi di Modena and Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

› Author Affiliations

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

Full Text

References

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