title: Cardiac catheterization in patients with end-stage liver disease: safety and outcomes.
abstract: BACKGROUND
  Patients with end-stage liver disease (ESLD) awaiting transplant are at increased risk of bleeding. Nevertheless, these patients routinely undergo cardiac catheterization for various indications. Safety and outcomes of cardiac catheterization in these patients are not well reported.
  
  
  METHODS
  In a case-control study 43 patients with ESLD who underwent angiography for liver transplant work-up were compared to 43 age and gender-matched controls with no liver dysfunction. In-hospital outcomes and procedural variables were compared.
  
  
  RESULTS
  Patients with ESLD had a lower baseline hemoglobin (12.1 ± 2.1 vs. 13.7 ± 1.8, P < 0.0005), lower platelet counts (86.8 ± 66 vs. 247 ± 80, P < 0.0001) and higher international normalized ratio (INR) (1.4 ± 0.2 vs. 1.1 ± 0.2, P < 0.0001) than controls. Among ESLD group, five (11.6%) patients received platelet transfusions, one received blood transfusion, and three patients (7%) with INR > 1.6 received fresh frozen plasma (FFP) compared with none in the control group. Smaller size (four French) vascular sheaths were used more frequently in the group with ESLD (16% vs. 4%, P = 0.04). There were no significant vascular or bleeding complications in either group.
  
  
  CONCLUSIONS
  Elective cardiac catheterization can be safely performed in patients with ESLD with outcomes (vascular and bleeding complications, length of hospital stay and in-hospital mortality) similar to patients without liver disease despite significant thrombocytopenia and elevated INR in patients with ESLD. Practices such as platelet transfusion for platelets <60,000 μL, prophylactic FFP transfusion for INR ≥ 1.6, less frequent use of antiplatelet therapy and more frequent use of smaller vascular sheaths may have contributed to the safety of cardiac catheterization in ESLD patients.
authors.affiliation: University of Kansas Hospital, Mid America Cardiology, Kansas City, Kansas 66160, USA.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.forename: Pavan
authors.initials: P
authors.lastname: Patel
authors.forename: Sowjanya
authors.initials: S
authors.lastname: Duthuluru
authors.forename: Jenny
authors.initials: J
authors.lastname: Roberts
authors.forename: Warren
authors.initials: W
authors.lastname: Chen
authors.forename: Randall
authors.initials: R
authors.lastname: Genton
authors.forename: Mark
authors.initials: M
authors.lastname: Wiley
authors.forename: Robert
authors.initials: R
authors.lastname: Candipan
authors.forename: Peter
authors.initials: P
authors.lastname: Tadros
authors.forename: Kamal
authors.initials: K
authors.lastname: Gupta
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D001803:Blood Transfusion; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D016022:Case-Control Studies; D057785:Catheters; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation; D058625:End Stage Liver Disease / Q000097:blood / Q000150:complications*; D004867:Equipment Design; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006801:Humans; D019934:International Normalized Ratio; D007615:Kansas; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010976:Platelet Count; D017713:Platelet Transfusion; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors