Tu1277 Endoscopic Variceal Ligation (EVL) Is Safe in Cirrhotic Patients With Severe Thrombocytopenia

Abstract

Endoscopic Variceal Ligation (EVL) Is Safe in Cirrhotic Patients With Severe Thrombocytopenia Nithi Thinrungroj, Pises Pisespongsa*, Phuripong Kijdamrongthum, Apinya Leerapun, Taned Chitapanarux, Satawat Thongsawat, Ong-ARD Praisontarangkul Medicine, Chiangmai University, Chiangmai, Thailand Background & Aims: EVL is the treatment of choice for esophageal variceal bleeding (EVB). However post-EVL ulcer bleeding is not uncommon and can cause significant morbidity and mortality. Whether severe thrombocytopenia and coagulopathy really are the risks of post-EVL ulcer bleeding remains inconclusive. We aimed to assess the risk of post-EVL ulcer bleeding in cirrhotic patients with severe thrombocytopenia and coagulopathy in real-life settings. Methods: Cirrhotic patients who had EVL performed for secondary EVB prophylaxis in Chiang Mai University hospital from January 2011 to December 2011 were included. Due to shortage in blood components, we have certain experience in performing EVL in patients with acute EVB who were thrombocytopenic. Hence, we extend this into performing EVL in several patients with severe thrombocytopenia and prolonged prothrombin time (PT). The patients’ demographic, clinical, laboratory and endoscopic data were reviewed. The post-EVL ulcer bleeding was determined and evaluated. Results: One hundred and sixteen patients with 164 EVL sessions were included. Eightyfive were male and 31 were female. There were 13 post-EVL bleeding (7.9%). Severe thrombocytopenia (platelets count 50,000/mm3) was observed in 24 sessions (14.63%) and prolonged PTas PT-INR 1.5 in 24 sessions (14.63%). The proportion of Child-Pugh score class C, active alcohol drinking, propranolol using, large EV, and GV were not different between bleeders and non-bleeders. The platelets count, PT, and hematocrit were also not different between two groups. There were 3 post-EVL bleeding in patients with platelets count 50,000/mm3 (12.5%) compare with 10 bleeding (7.6%) in patients with platelets count 50,000/mm3 (p 0.408). Surprisingly, there was no bleeding among 6 patients who had platelets count 30,000/mm3 (p 1.0). The bleeding rate in patients with PT-INR 1.5 was also not increased (9% vs 8.5%, p 1.0) Conclusions: Post-EVL ulcer bleeding was not associated with severe thrombocytopenia and prolonged PT, and the safe platelets count cut-off for EVL may be as low as 30,000/ mm3. The determining risk for bleeding should be looked for beyond just bleeding tendency. The larger scale prospective study is needed to confirm the safety level of platelets count.