Staging the pre-procedural prophylaxis in decompensated cirrhosis.

Abstract

We read with interest the article by Tosetti et al, published recently in Digestive and Liver Disease [ [1] Tosetti G. Farina E. Caccia R. et al. Preprocedural prophylaxis with blood products in patients with cirrhosis: results from a survey of the Italian Association for the Study of the Liver (AISF). Dig Liv Dis. 2022; https://doi.org/10.1016/j.dld.2022.03.017 Abstract Full Text Full Text PDF Scopus (4) Google Scholar ]. By circulating a web survey within hepatologists and gastroenterologists affiliated with the Italian Association for the Study of the Liver (AISF), they investigated the current practice of pre-procedural prophylaxis in patients with cirrhosis in Italy. They found that: approximately all responders use INR and/or platelet count to predict bleeding risk; thresholds of INR to identify patients at risk vary significantly among centers; prophylaxis is commonly prescribed in patients with INR >1.5 and/or platelet count <50 × 109/L; low-risk procedures account for the majority of blood products transfusions, mostly fresh frozen plasma and platelets [ [1] Tosetti G. Farina E. Caccia R. et al. Preprocedural prophylaxis with blood products in patients with cirrhosis: results from a survey of the Italian Association for the Study of the Liver (AISF). Dig Liv Dis. 2022; https://doi.org/10.1016/j.dld.2022.03.017 Abstract Full Text Full Text PDF Scopus (4) Google Scholar ]. Preprocedural prophylaxis with blood products in patients with cirrhosis: Results from a survey of the Italian Association for the Study of the Liver (AISF)Digestive and Liver DiseaseVol. 54Issue 11PreviewThe concept of rebalanced hemostasis in cirrhosis challenges the policy of transfusing plasma or platelets before invasive procedures in patients with prolonged PT or severe thrombocytopenia. Recent guidelines recommend against plasma transfusion and suggest avoiding/minimizing platelet transfusions. Full-Text PDF Author's reply: "Staging the pre-procedural prophylaxis in decompensated cirrhosis"Digestive and Liver DiseaseVol. 54Issue 8PreviewWe thank Zanetto and colleagues for their comments [1] on our survey concerning preprocedural prophylaxis in patients with cirrhosis in Italy [2], which allows us to add some previously unreported data. Full-Text PDF