2948 Does Thrombocytopenia in Cirrhotic Patients Improve After Transjugular Intrahepatic Portosystemic Shunt?

Abstract

INTRODUCTION: Thrombocytopenia (TP) is commonly encountered in cirrhotic patients, likely secondary to splenic congestion from portal hypertension. The few available studies showed inconsistent effect of Transjugular Intrahepatic Portosystemic Shunt (TIPS) on thrombocytopenia and were limited mostly by short term (≤3 months) follow up after TIPS which can underestimate the effect. Moreover, the majority of studies did not examine the predictors of improved thrombocytopenia, so it is not clear which patients would benefit from the procedure. In this study, we assess the effect of TIPS on TP up to 6 months after TIPS. METHODS: We conducted a retrospective study including adults with cirrhosis who underwent TIPS at Tertiary referral center between January 2016 and June 2018. Only patients with average platelet count <150 k/ul in the 3 months before TIPS were included. Charts were manually reviewed to collect baseline and outcome variables. The shunt patency was ensured using Doppler ultrasound in 3-6 months after TIPS. Primary outcome was the percentage of patients with improved TP after TIPS. This was defined based on the difference between average count in the 3 months before TIPS and the average count in the 3-6 months after. Secondary outcome was to determine the predictors of improved TP on a multivariate logistic regression model. RESULTS: Forty-one patients were included. Table 1 shows the demographic and clinical characteristics of the patients. 22 patients (54%) had an improved TP after TIPS (median absolute rise 15.04 [0.25, 133.67], median percent increase 14.59% [0.40, 122.26] (Figure 1). The majority of patients (13/22) had mild improvement by <20 k/ul. The improved TP group had more variceal bleed as an indication for TIPS, lower pre-TIPS average platelet count, and a lower pre-TIPS portosystemic pressure gradient (PSPG). The predictors of improved TP were TIPS for variceal bleeding rather than refractory ascites; OR 31 [2.3-432], lower mean platelets count before TIPS, OR 0.96 [0.93-0.99] and lower change in PSPG; OR 0.55 [0.32-0.95]. CONCLUSION: Our result is in agreement with previous studies that showed improvement in TP in a subset of patients following TIPS. However, the improvement was modest in most patients. Predictors of improvement in our cohort were lower pre-TIPS average platelet count, lower pre-TIPS PSPG, and variceal bleeding as an indication for TIPS placement. More studies are demanded to validate the role of TIPS in the management of TP.