Liver

17 - Low Incidence of Bleeding Events With a Restrictive Platelet Transfusion Protocol in Patients With Cirrhosis and Concomitant End Stage Renal Disease

Monday, October 8
2:35 PM - 2:45 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: Liver
Lauren S. Cole, MD1, Michael Rowley, MD2, Sumit Agarwal, MBBS, MBA3, Anil Seetharam, MD2
1University of Arizona College of Medicine, Scottsdale, AZ; 2University of Arizona College of Medicine, Phoenix, AZ; 3Banner University Medical Center, Phoenix, AZ

Introduction: Management of ascites in cirrhosis with concomitant end-stage renal disease (ESRD) presents a challenge as diuretic titration and transjugular portosystemic shunt (TIPS) effectiveness are limited. Patients are often managed with serial large volume paracentesis (LVPs); both quantitative and qualitative platelet dysfunction may increase LVP bleed risk. Society guidelines differ with respect to minimum platelet thresholds for safe LVP. The primary aim of this study was to characterize rate of bleeding in a population with cirrhosis and ESRD receiving LVP with a restrictive platelet transfusion strategy.

Methods: Retrospective study of consecutive inpatients LVP at a tertiary medical center between January 2016 and December 2017.  Institutional clinical census developed a protocol in which no patients received fresh frozen plasma (FFP), platelets or desmopressin prior to ultrasound guided LVP. Records tabulated: date/time of LVP, complete blood profile (CBC), INR and model for end stage liver disease (MELD score) on day of procedure, any blood products transfused during inpatient stay, and any angiogram procedures performed.  Details of any secondary hospital encounter within 2 weeks of LVP reviewed.

Results: 757 inpatients underwent usLVP.   Mean INR, platelet count and MELD was 2.1 (1.7-2.8), 124 (11-157k) and 24 (21-36) respectively.  35% of patients had INRs > 2.0.   131 patients (17%) had platelet counts < 50k and 32 patients (4%) had < 30k.   260 patients (34%) were on renal replacement therapy RRT) at the time of usLVP.  An additional 52 patients had Cr >2.0 (7%).  Only 1 of 757 patients (0.13%) had post-LVP bleeding requiring transfusion of 2 units of packed red blood cells.  No patient required angiogram intervention for bleeding and no patient died from LVP related complications.

Discussion: Incidence of bleeding with ultrasound guided LVP is very rare, even in a high risk patient population with severe renal dysfunction and thrombocytopenia.  Prophylactic product transfusion or desmopressin do not appear warranted in this high risk population.


Disclosures:
Lauren Cole indicated no relevant financial relationships.
Michael Rowley indicated no relevant financial relationships.
Sumit Agarwal indicated no relevant financial relationships.
Anil Seetharam indicated no relevant financial relationships.

Lauren S. Cole

Internal Medicine Resident Physician
University of Arizona College of Medicine Phoenix
Scottsdale, Arizona

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