A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation

Background & Aims: Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evalua...

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Autores principales:	Annabel Blasi, Salvador Machlab, Raquel Risco, Joao Pedro Costa-Freixas, Geovanny Hernández-Cely, Diana Horta, Alex Bofill, Pablo Ruiz-Ramirez, Joaquim Profitos, Josep Marti Sanahuja, Alejandro Fernandez-Simon, Mercedes Vergara Gómez, Jordi Sánchez-Delgado, Andrés Cardenas
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	acute variceal bleeding cirrhosis MELD score Child Score endoscopic band ligation esophageal varices Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/3ff7c087bc3c482dbd69a73d13e1d469
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spelling	oai:doaj.org-article:3ff7c087bc3c482dbd69a73d13e1d4692021-11-20T05:11:47ZA multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation2589-555910.1016/j.jhepr.2021.100363https://doaj.org/article/3ff7c087bc3c482dbd69a73d13e1d4692021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2589555921001397https://doaj.org/toc/2589-5559Background & Aims: Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL). Methods: This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1.5 and/or platelet count <50x109/L. Patient demographics, endoscopic findings, bleeding events after EBL, and the use of prophylactic FFP or platelets were recorded. Results: A total of 536 patients underwent 1,472 EBL procedures: 72% male; main etiology HCV and alcohol (72%); median MELD score 11; Child-Pugh A/B/C (59/33/8%). EBL procedures were performed for primary (51%) or secondary (49%) prophylaxis. A median of 2 procedures per patient were performed.1-4 FFP and/or platelets were administered in 41 patients (7.6%). The prophylactic transfusion protocol was followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post-EBL bleeding occurred in 26 out of 536 patients (4.8%) and in 33 out of 1,472 procedures (2.2%). Bleeding was due to post-EBL ulcers in 21 patients and due to band dislodgment in 5. In 6 patients, bleeding occurred within 24 hours and in the remaining patients it occurred within 2 weeks after EBL. In those that bled, 7 met criteria for transfusion (2 for FFP and 5 for platelets), of whom only 1 received FFP and 4 received platelets; the remaining 19 patients did not meet criteria for transfusion. There was no association between INR or platelet count and bleeding events. Univariate and multivariate analysis revealed that Child-Pugh and MELD scores were risk factors for post-EBL bleeding. Conclusions: The incidence of post-EBL bleeding is low and is associated with advanced liver disease. Post-EBL bleeding was not related to baseline INR/platelet count and most outpatients with post-EBL bleeding did not meet criteria for prophylactic transfusion. Lay summary: Patients with chronic liver disease or cirrhosis and enlarged veins (varices) of the esophagus that can potentially bleed commonly need an endoscopy to treat these varices with elastic rubber bands (endoscopic band ligation). Some patients have low platelet counts or prolonged coagulation tests. This analysis of 4 centers evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation. The results showed that bleeding after band ligation is uncommon and that if bleeding occurs it does not seem to be related with coagulation tests or the administration of blood products to prevent bleeding after band ligation of esophageal varices.Annabel BlasiSalvador MachlabRaquel RiscoJoao Pedro Costa-FreixasGeovanny Hernández-CelyDiana HortaAlex BofillPablo Ruiz-RamirezJoaquim ProfitosJosep Marti SanahujaAlejandro Fernandez-SimonMercedes Vergara GómezJordi Sánchez-DelgadoAndrés CardenasElsevierarticleacute variceal bleedingcirrhosisMELD scoreChild Scoreendoscopic band ligationesophageal varicesDiseases of the digestive system. GastroenterologyRC799-869ENJHEP Reports, Vol 3, Iss 6, Pp 100363- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute variceal bleeding cirrhosis MELD score Child Score endoscopic band ligation esophageal varices Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	acute variceal bleeding cirrhosis MELD score Child Score endoscopic band ligation esophageal varices Diseases of the digestive system. Gastroenterology RC799-869 Annabel Blasi Salvador Machlab Raquel Risco Joao Pedro Costa-Freixas Geovanny Hernández-Cely Diana Horta Alex Bofill Pablo Ruiz-Ramirez Joaquim Profitos Josep Marti Sanahuja Alejandro Fernandez-Simon Mercedes Vergara Gómez Jordi Sánchez-Delgado Andrés Cardenas A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
description	Background & Aims: Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL). Methods: This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1.5 and/or platelet count <50x109/L. Patient demographics, endoscopic findings, bleeding events after EBL, and the use of prophylactic FFP or platelets were recorded. Results: A total of 536 patients underwent 1,472 EBL procedures: 72% male; main etiology HCV and alcohol (72%); median MELD score 11; Child-Pugh A/B/C (59/33/8%). EBL procedures were performed for primary (51%) or secondary (49%) prophylaxis. A median of 2 procedures per patient were performed.1-4 FFP and/or platelets were administered in 41 patients (7.6%). The prophylactic transfusion protocol was followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post-EBL bleeding occurred in 26 out of 536 patients (4.8%) and in 33 out of 1,472 procedures (2.2%). Bleeding was due to post-EBL ulcers in 21 patients and due to band dislodgment in 5. In 6 patients, bleeding occurred within 24 hours and in the remaining patients it occurred within 2 weeks after EBL. In those that bled, 7 met criteria for transfusion (2 for FFP and 5 for platelets), of whom only 1 received FFP and 4 received platelets; the remaining 19 patients did not meet criteria for transfusion. There was no association between INR or platelet count and bleeding events. Univariate and multivariate analysis revealed that Child-Pugh and MELD scores were risk factors for post-EBL bleeding. Conclusions: The incidence of post-EBL bleeding is low and is associated with advanced liver disease. Post-EBL bleeding was not related to baseline INR/platelet count and most outpatients with post-EBL bleeding did not meet criteria for prophylactic transfusion. Lay summary: Patients with chronic liver disease or cirrhosis and enlarged veins (varices) of the esophagus that can potentially bleed commonly need an endoscopy to treat these varices with elastic rubber bands (endoscopic band ligation). Some patients have low platelet counts or prolonged coagulation tests. This analysis of 4 centers evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation. The results showed that bleeding after band ligation is uncommon and that if bleeding occurs it does not seem to be related with coagulation tests or the administration of blood products to prevent bleeding after band ligation of esophageal varices.
format	article
author	Annabel Blasi Salvador Machlab Raquel Risco Joao Pedro Costa-Freixas Geovanny Hernández-Cely Diana Horta Alex Bofill Pablo Ruiz-Ramirez Joaquim Profitos Josep Marti Sanahuja Alejandro Fernandez-Simon Mercedes Vergara Gómez Jordi Sánchez-Delgado Andrés Cardenas
author_facet	Annabel Blasi Salvador Machlab Raquel Risco Joao Pedro Costa-Freixas Geovanny Hernández-Cely Diana Horta Alex Bofill Pablo Ruiz-Ramirez Joaquim Profitos Josep Marti Sanahuja Alejandro Fernandez-Simon Mercedes Vergara Gómez Jordi Sánchez-Delgado Andrés Cardenas
author_sort	Annabel Blasi
title	A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
title_short	A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
title_full	A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
title_fullStr	A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
title_full_unstemmed	A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
title_sort	multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/3ff7c087bc3c482dbd69a73d13e1d469
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A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation

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