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Invasive Procedures in Patients with Cirrhosis: A Clinical Approach Based on Current Evidence

Annabel Blasi1, Andres Cardenas2

  • 1Anesthesia Department, Hospital Clinic of Barcelona, Villarroel 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) and Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.

Clinics in Liver Disease
|April 11, 2021
PubMed

Insights

This article updates on coagulation disturbances in cirrhosis patients, covering bleeding risks and prophylactic measures for invasive procedures. It provides expert recommendations for managing bleeding complications in liver disease.

Area of Science:

  • Hepatology
  • Hematology
  • Clinical Medicine

Background:

  • Cirrhosis frequently causes complex coagulation disturbances.
  • Understanding these hemostatic abnormalities is crucial for patient management.
  • Traditional coagulation tests may not accurately reflect bleeding risk in cirrhosis.

Purpose of the Study:

  • To provide an updated overview of coagulation disturbances in cirrhosis.
  • To summarize current methods for predicting bleeding risk.
  • To outline evidence-based prophylactic strategies for invasive procedures.

Main Methods:

  • Literature review of coagulation in cirrhosis.
  • Analysis of diagnostic tests for bleeding prediction.
  • Synthesis of expert recommendations for prophylactic measures.

Main Results:

  • Detailed explanation of the pathophysiology of coagulopathy in cirrhosis.
  • Evaluation of the utility and limitations of various hemostatic assays.
  • Discussion on the risks associated with invasive procedures in cirrhotic patients.

Conclusions:

  • Coagulation management in cirrhosis requires a nuanced approach beyond standard laboratory tests.
  • Prophylactic measures should be tailored based on individual patient risk and procedural type.
  • Expert consensus provides guidance for optimizing hemostasis and minimizing bleeding complications.

Keywords:
CirrhosisCoagulopathyEndoscopic band ligationInvasive proceduresPlasma transfusionPlatelet transfusionPortal hypertensionThromboelastography

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