Low Fibrinogen Levels Are Associated with Bleeding After Varices Ligation in Thrombocytopenic Cirrhotic Patients.

Annals of Hepatology
Edoardo G GianniniVincenzo Savarino

Abstract

EVBL is a procedure frequently performed in cirrhotic patients for primary prophylaxis of bleeding. Patients with cirrhosis display various degrees of alteration of common coagulation parameters, and it is not known whether these alterations may predict post-EVBL bleeding. To evaluate factors predictive of post-endoscopic variceal band ligation (EVBL) bleeding in cirrhotic patients with thrombocytopenia. We included 109 patients with cirrhosis undergoing EVBL for primary prophylaxis of variceal bleeding. Common coagulation parameters (INR, fibrinogen levels) and complete haemogram were obtained in all patients and evaluated subdividing patients in bleeders and non bleeders following EVBL. The incidence of post-EVBL bleeding was 5.5% (6 patients). INR and platelet counts, considered as continuous or dichotomous variables according to common cut-offs (i.e., INR>1.5, platelet count <50x109/L) were not predictors of post-EVBL bleeding. Patients who bled had significantly lower fibrinogen levels [146 mg/dL (98 - 262) versus 230 mg/dL (104 - 638), P=0.009], and no other biochemical or clinical predictors of bleeding were identified. A fibrinogen cut-off of 179 mg/dL had 98.6% negative predictive value for bleeding. low fibrinog...Continue Reading

Citations

Sep 18, 2018·Liver International : Official Journal of the International Association for the Study of the Liver·Edoardo G GianniniElisa Marabotto
Mar 8, 2019·Journal of Veterinary Internal Medicine·Cynthia R L WebsterPenny J Watson
Oct 30, 2019·European Journal of Haematology·Patricia LiuJoseph Shatzel
Apr 29, 2020·Hepatic Medicine : Evidence and Research·Samuel H SigalArun Jesudian
Feb 11, 2020·JHEP Reports : Innovation in Hepatology·Laura TurcoErica Villa
Nov 22, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Patrick G NorthupDominique C Valla
Nov 10, 2020·Clinical Liver Disease·Madhumita Premkumar, Shiv Kumar Sarin

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