Abstract
BackgroundThere are limited studies assessing whether prophylactic platelet transfusions prior to high-risk procedures reduce the risk of bleeding in patients with liver cirrhosis. MethodsWe performed a post-hoc analysis of two prior randomized clinical trials (CTRI/2017/12/010822 and CTRI/2021/05/033464), which compared TEG-guided prophylactic platelet transfusion to standard of care (empirical prophylactic transfusion for all patients prior to the procedure) or on-demand transfusion (no prophylactic transfusions). We aimed to assess the risk of major procedure-related bleeding or mortality among patients who had received prophylactic platelet transfusions versus those who did not (on-demand transfusions). ResultsA total of 118 patients were included in the analysis, with baseline demographics well matched between groups. The leading etiologies of cirrhosis were cryptogenic (42, 35.6%) and autoimmune liver disease (30, 25.4%). The most common procedures performed were percutaneous liver biopsy (73, 61.8%), followed by transjugular intrahepatic portosystemic shunt (14,11.9%) and transarterial chemoembolization (14,11.9%) respectively. No episode of major bleeding or procedure-related mortality occurred in either group, though minor bleeding occurred in 5 patients. A significantly lower number of patients in the on-demand group required platelet transfusions compared to those receiving empirical transfusions as part of standard care. ConclusionProcedure-related bleeding rates were not significantly higher among patients with liver cirrhosis undergoing high-risk procedures without prophylactic platelet transfusions compared to those who received them. Larger randomized trials are required to validate these findings from our post-hoc analysis.
Published Version
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