A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
Blasi, Annabel (Hospital Clínic i Provincial de Barcelona)
Machlab, Salvador (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Risco, Raquel (Hospital Clínic i Provincial de Barcelona)
Costa-Freixas, Joao Pedro (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Hernández-Cely, Geovanny (Hospital Clínic i Provincial de Barcelona)
Horta Sangenís, Diana (Hospital Universitari MútuaTerrassa)
Bofill, Alex (Hospital Clínic i Provincial de Barcelona)
Ruiz-Ramirez, Pablo (Hospital Universitari MútuaTerrassa)
Profitos, Joaquim (Consorci Sanitari de Terrassa)
Sanahuja, Josep Marti (Hospital Clínic i Provincial de Barcelona)
Fernandez-Simon, Alejandro (Hospital Clínic i Provincial de Barcelona)
Vergara, Mercedes (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Sánchez-Delgado, Jordi (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Cardenas, Andrés (Hospital Clínic i Provincial de Barcelona)

Date:	2021
Abstract:	Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL). This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1. 5 and/or platelet count <50x10 9 /L. Patient demographics, endoscopic findings, bleeding events after EBL, and the use of prophylactic FFP or platelets were recorded. A total of 536 patients underwent 1,472 EBL procedures: 72% male; main etiology HCV and alcohol (72%); median MELD score 11; Child-Pugh A/B/C (59/33/8%). EBL procedures were performed for primary (51%) or secondary (49%) prophylaxis. A median of 2 procedures per patient were performed. 1-4 FFP and/or platelets were administered in 41 patients (7. 6%). The prophylactic transfusion protocol was followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post-EBL bleeding occurred in 26 out of 536 patients (4. 8%) and in 33 out of 1,472 procedures (2. 2%). Bleeding was due to post-EBL ulcers in 21 patients and due to band dislodgment in 5. In 6 patients, bleeding occurred within 24 hours and in the remaining patients it occurred within 2 weeks after EBL. In those that bled, 7 met criteria for transfusion (2 for FFP and 5 for platelets), of whom only 1 received FFP and 4 received platelets; the remaining 19 patients did not meet criteria for transfusion. There was no association between INR or platelet count and bleeding events. Univariate and multivariate analysis revealed that Child-Pugh and MELD scores were risk factors for post-EBL bleeding. The incidence of post-EBL bleeding is low and is associated with advanced liver disease. Post-EBL bleeding was not related to baseline INR/platelet count and most outpatients with post-EBL bleeding did not meet criteria for prophylactic transfusion. Patients with chronic liver disease or cirrhosis and enlarged veins (varices) of the esophagus that can potentially bleed commonly need an endoscopy to treat these varices with elastic rubber bands (endoscopic band ligation). Some patients have low platelet counts or prolonged coagulation tests. This analysis of 4 centers evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation. The results showed that bleeding after band ligation is uncommon and that if bleeding occurs it does not seem to be related with coagulation tests or the administration of blood products to prevent bleeding after band ligation of esophageal varices.
Grants:	Instituto de Salud Carlos III PI19/00752
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute variceal bleeding ; Child Score ; Cirrhosis ; EBL, endoscopic band ligation ; Endoscopic band ligation ; Esophageal varices ; FFP, fresh frozen plasma ; Fresh frozen plasma ; Gastrointestinal bleeding ; INR, international normalized ratio ; MELD score ; MELD, model for end-stage liver disease ; Platelets ; Platelet transfusion ; Post-band ligation ulcer ; Primary prophylaxis ; Secondary prophylaxis
Published in:	JHEP Reports, Vol. 3 (september 2021) , ISSN 2589-5559

DOI: 10.1016/j.jhepr.2021.100363
PMID: 34765959

7 p, 553.0 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles