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Indian Journal of Gastroenterology

, Volume 34, Issue 5, pp 359–364 | Cite as

Coagulopathy in cirrhosis: A prospective study to correlate conventional tests of coagulation and bleeding following invasive procedures in cirrhotics

  • Apurva ShahEmail author
  • Deepak Amarapurkar
  • Mrudul Dharod
  • Madhuri Chandnani
  • Rajiv Baijal
  • Praveen Kumar
  • Mayank Jain
  • Nikhil Patel
  • Praful Kamani
  • Sonali Gautam
  • Nimish Shah
  • Sandeep Kulkarni
  • Soham Doshi
Original Article

Abstract

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.

Keywords

Hemostasis Liver biopsy Paracentesis Procoagulant 

Notes

Conflict of Interest

AS, DA, MD, MC, RB, PK, MJ, NP, PK, SG, NS, SK, and SD declare that they have no competing interests.

Ethics statement

The study was performed in a manner to conform to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and that the authors followed the policy concerning informed consent as shown on Springer.com

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Copyright information

© Indian Society of Gastroenterology 2015

Authors and Affiliations

  • Apurva Shah
    • 1
    Email author
  • Deepak Amarapurkar
    • 1
  • Mrudul Dharod
    • 1
  • Madhuri Chandnani
    • 1
  • Rajiv Baijal
    • 2
  • Praveen Kumar
    • 2
  • Mayank Jain
    • 3
  • Nikhil Patel
    • 4
  • Praful Kamani
    • 5
  • Sonali Gautam
    • 1
  • Nimish Shah
    • 2
  • Sandeep Kulkarni
    • 2
  • Soham Doshi
    • 2
  1. 1.Department of GastroenterologyBombay Hospital and Medical Research CenterMumbaiIndia
  2. 2.Department of GastroenterologyJagjivan Ram HospitalMumbaiIndia
  3. 3.Department of GastroenterologyChoitharam Hospital and Research CentreIndoreIndia
  4. 4.Department of GastroenterologyJivandeep HospitalAnandIndia
  5. 5.Department of GastroenterologyWockhardt HospitalRajkotIndia

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