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Digestive Disease Interventions 2017; 01(04): 306-312
DOI: 10.1055/s-0038-1629916
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Periprocedural Bleeding Risk Assessment in Chronic Liver Disease

Benjamin J. May
1   Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
,
Brett E. Fortune
2   Division of Gastroenterology and Hepatology, Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
,
David C. Madoff
1   Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
› Author Affiliations
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Publication History

10 October 2017

03 January 2018

Publication Date:
27 February 2018 (online)

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Abstract

Invasive procedures are common in the management of cirrhosis-related chronic liver disease (CLD). Assessing bleeding risk prior to these procedures is challenging because of commonly seen laboratory abnormalities among traditional testing used to evaluate bleeding risk in patients with advanced liver disease. However, this ‘coagulopathy’ seen in advanced liver disease is not a true bleeding or clotting disorder. The prothrombin time/international normalized ratio (PT/INR) test is frequently elevated in CLD patients, but has been shown to poorly correlate with bleeding risk in this population. A traditional interpretation of this laboratory test can lead to unnecessary transfusion of blood product, procedure delay, or even potential harm to the patient. An understanding of the ‘coagulopathy’ of advanced liver disease and alternative methods, to more accurately assess bleeding risk, allows clinicians to treat safely CLD patients.

Keywords

chronic liver disease - bleeding risk - coagulopathy - fresh frozen plasma - viscoelastic testing
 

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