Evaluation of INR Elevation in Cirrhotic Patients as a Risk Factor for Esophageal Variceal Bleeding

Ahmad Abdel Moti,Nagla Hassan

doi:10.21608/aeji.2017.17789

Abstract

Background and study aim: Bleeding esophageal varices is a life threatening complication in cirrhotic patients. So, studying risk factors for bleeding esophageal varices is a must. Because of complexity and dynamic nature of coagulation process in cirrhotic patients, INR is considered a false method to measure bleeding risk in such patients. This study aims at evaluating INR elevation in cirrhotic patients as a risk factor for esophageal variceal bleeding. Patients and Methods: This case control study was conducted at the Intensive Care Unit and inpatient wards of Tropical Medicine Department affiliated to Zagazig University Hospitals in the period from April 2016 to January 2017. According to inclusion and exclusion criteria, 202 patients with liver cirrhosis and esophageal varices were included in this study. Cases were cirrhotic patients admitted to the hospital due to first attack of actively bleeding esophageal varices. Controls were cirrhoticpatients without bleeding esophageal varices admitted with ascites, SBP or hepatic encephalopathy. Results: Median admission INR was 1.3 in bleeders compared to 1.9 in non-bleeders with a highly significant statistical difference between both groups. Conclusion: Study concluded that INR elevation reflects the degree of liver dysfunction not the risk of bleeding from esophageal varices.

Highlights

Bleeding from esophageal varices in cirrhotic patients is considered a life threatening complication despite the improvement of medical and endoscopic lines of treatment with mortality ranging from 15 to 20 % [1].Correction of coagulopathy which is reflected by elevation of INR by fresh frozen plasma is a common clinical procedure during management of bleeding from esophageal varices
Severe hemorrhage from esophageal varices depends on portal hypertension more than function of the clotting cascade [3]
It was estimated that esophageal varices develop in about 50-63% of patients with liver cirrhosis and portal hypertension

Summary

Introduction

Bleeding from esophageal varices in cirrhotic patients is considered a life threatening complication despite the improvement of medical and endoscopic lines of treatment with mortality ranging from 15 to 20 % [1]. Correction of coagulopathy which is reflected by elevation of INR by fresh frozen plasma is a common clinical procedure during management of bleeding from esophageal varices. American Association for the Study of Liver Diseases (AASLD) recommends correction of coagulopathy and /or thrombocytopenia by transfusion of fresh frozen plasma and / or platelets in the setting of variceal bleeding [2]. Bleeding esophageal varices is a life threatening complication in cirrhotic patients. Studying risk factors for bleeding esophageal varices is a must. This study aims at evaluating INR elevation in cirrhotic patients as a risk factor for esophageal variceal bleeding

Objectives

Methods

Conclusion