title: A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation.
abstract: OBJECTIVE
  There is controversy over whether coagulation status predicts bleeding caused by ulceration after esophageal varices band ligation (EVL).
  
  
  METHODS
  EVL was performed for primary (n = 45) or secondary (n = 105) prophylaxis in 150 patients with cirrhosis (Child A, n = 74, 49%; Child B, n = 42, 28%; Child C, n = 34, 23%). International normalized ratio (INR) and platelet counts were assessed in all. In 92 patients, levels of factor V, fibrinogen, D-dimer, protein C and protein S, von Willebrand factor, and thromboelastography (TEG) were assessed. Platelet count <50 x 10(3)/mm(3) and INR >1.5 were considered high-risk cutoff for bleeding. Conversely, platelet count >or=50 x 10(3)/mm(3) with INR <or=1.5 were safe cutoffs.
  
  
  RESULTS
  Overall, 11 patients (7.3%) had post-EVL ulcer bleeding. Bleeding occurred in 5 patients with Child A/B (4.3%) and 6 patients with Child C (17%) (P = .0174 for Child A/B versus Child C). Eight patients with bleeding were among the 110 below the cutoff for INR and platelet count, whereas only 3 of the patients with bleeding were among the 40 patients with purported high-risk values (P = 1.0). Among the 92 patients with expanded coagulation tests, bleeding occurred in 5. There was no difference in any of the coagulation parameters, including overall TEG patterns, between patients who did and did not bleed.
  
  
  CONCLUSIONS
  Post-EVL ulcer bleeding was associated with Child C status but not with conventional or expanded coagulation indices in cirrhotic patients without renal failure or infection undergoing elective EVL. These results call into question the common use of prophylactic procoagulants in the elective setting.
authors.affiliation: University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Evandra Cristina
authors.initials: EC
authors.lastname: Vieira da Rocha
authors.forename: Elbio Antonio
authors.initials: EA
authors.lastname: D'Amico
authors.forename: Stephen Hugh
authors.initials: SH
authors.lastname: Caldwell
authors.forename: Tania Rubia
authors.initials: TR
authors.lastname: Flores da Rocha
authors.forename: Cristina Simões Solon
authors.initials: CS
authors.lastname: Soares E Silva
authors.forename: Valdinelia
authors.initials: V
authors.lastname: Dos Santos Bomfim
authors.forename: Guilherme
authors.initials: G
authors.lastname: Felga
authors.forename: Walnei Fernandes
authors.initials: WF
authors.lastname: Barbosa
authors.forename: Fabio
authors.initials: F
authors.lastname: Kassab
authors.forename: Demerson Andre
authors.initials: DA
authors.lastname: Polli
authors.forename: Flair Jose
authors.initials: FJ
authors.lastname: Carrilho
authors.forename: Alberto Queiroz
authors.initials: AQ
authors.lastname: Farias
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000097:blood* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D019934:International Normalized Ratio; D008026:Ligation; D008103:Liver Cirrhosis / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000925:Anticoagulants