title: Bleeding after invasive procedures is rare and unpredicted by platelet counts in cirrhotic patients with thrombocytopenia.
abstract: BACKGROUND
  In cirrhotics with low circulating platelets (PLT), restoration of normal cell counts has been traditionally recommended before invasive procedures. However, there is neither consensus on the PLT transfusion threshold nor evidence of its clinical efficacy.
  
  
  METHODS
  In order to fill this gap of knowledge, we prospectively collected and analyzed data on circulating PLT counts [and International Normalized Ratio (INR)] values in a case series of 363 cirrhotics scheduled to undergo invasive investigations. PLT and/or fresh-frozen plasma (FFP) units were infused at the discretion of the attending physician, and the occurrence of post-procedural bleeding was related to pre-and post-infusion results.
  
  
  RESULTS
  852 Procedures were carried out in 363 cirrhotics sub-grouped according to the Child-Pugh-Turcotte (CPT) classification (class A/B/C: 124/154/85). The infusion of PLT and/or FFP improved only marginally circulating PLT counts and INR values. Ten post-procedural bleeds occurred in the whole case series, i.e. 1 episode every 85 procedures or every 36 patients. Post-procedural bleeding was unrelated to the PLT counts, to the degree of INR abnormalities, nor to the CPT classes, but was more frequent in patients who underwent repeated investigations. In the 10 patients with the most profound alterations in PLT and/or INR values, no post-procedural bleeding occurred.
  
  
  CONCLUSIONS
  In cirrhotic patients with low PLT and/or abnormal INR values undergoing invasive investigations, post-procedural bleeding was rare and unpredicted by PLT counts or abnormal INR values. In particular, the recommendation to infuse platelets when counts are <50×103/L is not substantiated by this case series of cirrhotic patients.
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Napolitano
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy. Electronic address: an.iacobellis@libero.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Iacobellis
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Merla
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Niro
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Valvano
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Terracciano
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Siena
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Caruso
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ippolito
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Cà Granda, Policlinico Maggiore Hospital Foundation and University of Milan, Italy.
authors.forename: Pier Mannucci
authors.initials: PM
authors.lastname: Mannuccio
authors.affiliation: Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D019934:International Normalized Ratio; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000453:epidemiology*
keywords: Bleeding; Cirrhosis; Coagulation; Hemorrhage; Liver cirrhosis; Platelets