Coagulopathy in cirrhosis: A prospective study to correlate  conventional tests of coagulation and bleeding following invasive  procedures in cirrhotics.
BACKGROUND
Conventional tests of coagulation which only measure procoagulant factors do not correctly estimate the actual in vivo hemostatic balance in cirrhosis. This prospective multicenter study was conducted to evaluate safety of various invasive procedures in the presence of abnormal coagulation tests and to correlate conventional coagulation parameters with clinically significant bleeding in cirrhotics.


METHODS
Three hundred and eighty patients (median age 54 years, 287 males) enrolled in the study were divided into two groups (A and B), according to the presence or absence of abnormal coagulation parameters (defined as INR ≥1.5 and/or platelet count ≤50,000/cum).


RESULTS
One hundred and twenty-eight patients (33.68%) were qualified in group A. Alcohol was the predominant etiology of cirrhosis (40% and 32% in groups A and B, respectively). The two groups were similar in baseline characteristics other than tests of coagulation and severity of liver disease. Low risk procedures (abdominal paracentesis most common) were carried out in 47% and 53% patients in two groups, respectively. None of the patients in either group had clinically significant bleeding. Similarly, high risk procedures (central vein cannulation, liver biopsy, etc.) were carried out in 14% and 10%, respectively, in two groups. Three patients in group A developed clinically significant bleeding, however, the difference was statistically nonsignificant (p=0.061). None of our patients received periprocedural correction of abnormal coagulation parameters with plasma/platelet concentrate.


CONCLUSIONS
Deranged conventional coagulation parameters did not predict clinically significant bleeding in cirrhosis. Whenever indicated, any invasive procedure could be safely carried out in patients with cirrhosis without prior correction of coagulation abnormalities.
Apurva
A
Shah
Deepak
D
Amarapurkar
Mrudul
M
Dharod
Madhuri
M
Chandnani
Rajiv
R
Baijal
Praveen
P
Kumar
Mayank
M
Jain
Nikhil
N
Patel
Praful
P
Kamani
Sonali
S
Gautam
Nimish
N
Shah
Sandeep
S
Kulkarni
Soham
S
Doshi
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects*; D001780:Blood Coagulation Tests; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006487:Hemostasis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood*; D008297:Male; D019152:Paracentesis / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies