Management of Coagulation Disorders in Patients With Cirrhosis
Publication Date: September 24, 2021
Last Updated: October 5, 2022
Diagnosis
Testing Strategy
Visco-elastic Testing (VET)
In patients with stable cirrhosis undergoing common gastrointestinal procedures, the AGA makes no recommendation regarding VET before procedures to predict bleeding risk. ( Evidence Gap , No recommendation )
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Treatment
Preprocedure Prophylaxis
PLT and/or Fresh Frozen Plasma (FFP)
In patients with stable cirrhosis undergoing common gastrointestinal procedures (e.g., paracentesis, thoracentesis, variceal banding, colonic polypectomy, ERCP, and liver biopsy), the AGA suggests against the routine use of blood products (e.g., FFP and PLTs) for bleeding prophylaxis. ( Very Low , Conditional (weak) )
Comment: This recommendation applies to the majority of patients with stable cirrhosis who usually do not have severe thrombocytopenia or severe coagulopathy. In patients with severe derangements in coagulation or thrombocytopenia undergoing a procedure that is high risk for bleeding, decisions about prophylactic blood transfusions should include discussions about potential benefits and risks (including transfusion reactions and delay of procedure) in consultation with a hematologist.
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Overview
Title
Management of Coagulation Disorders in Patients With Cirrhosis
Authoring Organization
American Gastroenterological Association