OBJECTIVES: Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship between platelet count and bleeding is still unclear. METHODS: We investigated the relationship between platelet count and major or clinical relevant nonmajor bleedings during a follow-up of ∼4 years. RESULTS: A total of 280 cirrhotic patients with different degrees of liver disease (67% males; age 64±37 years; 47% Child-Pugh B and C) were followed up for a median of 1,129 (interquartile range: 800-1,498) days yielding 953.12 patient-year of observation. The annual rate of any significant bleeding was 5.45%/year (3.57%/year and 1.89%/year for major and minor bleeding, respectively). Fifty-two (18.6%) patients experienced a major (n=34) or minor (n=18) bleeding event, predominantly from gastrointestinal origin. Platelet counts progressively decreased with the worsening of liver disease and were similar in patients with or without major or minor bleeding: a platelet count ≤50 × 103/μl was detected in 3 (6%) patients with and in 20 (9%) patients without any bleeding event. Conversely, prothrombin time-international normalized ratio was slightly higher in patients with overall or major bleeding. On Cox proportional hazard analysis, only a previous gastrointestinal bleeding (hazard ratio (HR): 1.96; 95% confidence interval: 1.11-3.47; P=0.020) and encephalopathy (HR: 2.05; 95% confidence interval: 1.16-3.62; P=0.013) independently predicted overall bleeding events. CONCLUSIONS: Platelet count does not predict unprovoked major or minor bleeding in cirrhotic patients.

Platelet Count Does Not Predict Bleeding in Cirrhotic Patients: Results from the PRO-LIVER Study

Valeria Raparelli;Roberto Manfredini
Membro del Collaboration Group
;
2018

Abstract

OBJECTIVES: Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship between platelet count and bleeding is still unclear. METHODS: We investigated the relationship between platelet count and major or clinical relevant nonmajor bleedings during a follow-up of ∼4 years. RESULTS: A total of 280 cirrhotic patients with different degrees of liver disease (67% males; age 64±37 years; 47% Child-Pugh B and C) were followed up for a median of 1,129 (interquartile range: 800-1,498) days yielding 953.12 patient-year of observation. The annual rate of any significant bleeding was 5.45%/year (3.57%/year and 1.89%/year for major and minor bleeding, respectively). Fifty-two (18.6%) patients experienced a major (n=34) or minor (n=18) bleeding event, predominantly from gastrointestinal origin. Platelet counts progressively decreased with the worsening of liver disease and were similar in patients with or without major or minor bleeding: a platelet count ≤50 × 103/μl was detected in 3 (6%) patients with and in 20 (9%) patients without any bleeding event. Conversely, prothrombin time-international normalized ratio was slightly higher in patients with overall or major bleeding. On Cox proportional hazard analysis, only a previous gastrointestinal bleeding (hazard ratio (HR): 1.96; 95% confidence interval: 1.11-3.47; P=0.020) and encephalopathy (HR: 2.05; 95% confidence interval: 1.16-3.62; P=0.013) independently predicted overall bleeding events. CONCLUSIONS: Platelet count does not predict unprovoked major or minor bleeding in cirrhotic patients.
Basili, Stefania; Raparelli, Valeria; Napoleone, Laura; Talerico, Giovanni; Roberto Corazza, Gino; Perticone, Francesco; Sacerdoti, David; Andriulli, Angelo; Licata, Anna; Pietrangelo, Antonello; Picardi, Antonio; Raimondo, Giovanni; Violi, Francesco; Palasciano, Giuseppe; D’Alitto, Felicia; Ostilio Palmieri, Vincenzo; Santovito, Daniela; Di Michele, Dario; Croce, Giuseppe; Brocco, Silvia; Fasolato, Silvano; Cecchetto, Lara; Bombonato, Giancarlo; Bertoni, Michele; Restuccia, Tea; Andreozzi, Paola; Livia Liguori, Maria; Caroleo, Benedetto; Perticone, Maria; Staltari, Orietta; Manfredini, Roberto; De Giorgi, Alfredo; Averna, Maurizio; Giammanco, Antonina; Granito, Alessandro; Pettinari, Irene; Marinelli, Sara; Bolondi, Luigi; Falsetti, Lorenzo; Salvi, Aldo; Durante-Mangoni, Emanuele; Cesaro, Flavio; Farinaro, Vincenzo; Ragone, Enrico; Morana, Ignazio; Ippolito, Antonio; Iacobellis, Angelo; Niro, Grazia; Merla, Antonio; Maimone, Sergio; Cacciola, Irene; Varvara, Doriana; Drenaggi, Davide; Staffolani, Silvia; Vespasiani-Gentilucci, Umberto; Galati, Giovanni; Gallo, Paolo; Davì, Giovanni; Schiavone, Cosima; Santilli, Francesca; Tana, Claudio; Soresi, Maurizio; Battista Bianchi, Giovanni; Carderi, Isabella; Pinto, Antonio; Tuttolomondo, Antonino; Ferrari, Giovanni; Gresele, Paolo; Fierro, Tiziana; Morelli, Olivia; Laffi, Giacomo; Giulio Romanelli, Roberto; Arena, Umberto; Stasi, Cristina; Gasbarrini, Antonio; Garcovich, Matteo; Assunta Zocco, Maria; Riccardi, Laura; Elena Ainora, Maria; Capeci, Willian; Pio Martino, Giuseppe; Nobili, Lorenzo; Cavallo, Maurizio; Frugiuele, Pierluigi; Greco, Antonio; Ventura, Paolo; Cuoghi, Chiara; Marcacci, Matteo; Serviddio, Gaetano; Vendemiale, Gianluigi; Villani, Rosanna; Gargano, Ruggiero; Vidili, Gianpaolo; Di Cesare, Valentina; Masala, Maristella; Delitala, Giuseppe; Invernizzi, Pietro; Ronca, Vincenzo; Di Minno, Giovanni; Tufano, Antonella; Purrello, Francesco; Privitera, Graziella; Forgione, Alessandra; Curigliano, Valentina; Senzolo, Marco; Isabel Rodríguez-Castro, Krissia; Giannelli, Gianluigi; Serra, Carla; Neri, Sergio; Pignataro, Pietro; Rizzetto, Mario; Wilma Debernardi, Venon; Svegliati Baroni, Gianluca; Bergamaschi, Gaetano; Masotti, Michela; Costanzo, Filippo; Figliomeni, Antonio; Angelico, Francesco; Del Ben, Maria; Polimeni, Licia; Proietti, Marco; Cangemi, Roberto; Francesco Romiti, Giulio; Toriello, Filippo; Sperduti, Nicolò; Santangelo, Giuseppe; Visioli, Giacomo; Todisco, Tommaso; Rita Vestri, Anna; Farcomeni, Alessio; Corrao, Salvatore; Gobbi, Paolo; Corradini, Elena; Costantino, Giorgio; Tripepi, Giovanni; Angelico, Mario; Granito, Alessandro; D’Amico, Gennaro; De Franchis, Roberto; Gatta, Angelo; Joseph Tassone, Eliezer; Anzaldi, Massimiliano; Barone, Milena; Bazzini, Cristina; Ilaria Bianchi, Paola; Boari, Benedetta; Bracco, Chrsitian; Buonauro, Agostino; Buttà, Carmelo; Buzzetti, Elena; Calabria, Stefano; Caradio, Federica; Carleo, Pietro; Domenica Carrabba, Maria; Castorani, Luigi; Cecchetto, Lara; Cicco, Sebastiano; Cimini, Claudia; Maria Colombo, Barbara; De Vuono, Stefano; Denegri, Andrea; Del Corso, Lisette; Di Giosia, Paolo; Donnarumma, Emilia; Giorgini, Paolo; Grassi, Davide; Grembiale, Alessandro; Hijazi, Daniel; Iamele, Luigi; Lorusso, Giusi; Marchese, Alessandra; Maria Marra, Alberto; Masala, Maristella; Miceli, Giuseppe; Montebianco Abenavoli, Ludovico; Murgia, Giuseppe; Naccarato, Paolo; Padula, Donatella; Pattoneri, Paolo; Perego, Francesca; Pesce, Paola; Petramala, Luigi; Piano, Salvatore; Pinto, Daniela; Pinna, Miriam; Serena Pignataro, Francesca; Pretti, Vincenzo; Pucci, Giacomo; Salinaro, Francesco; Salzano, Andrea; Santarossa, Claudia; Scarpini, Francesca; Scicali, Roberto; Sirico, Domenico; Suppressa, Patrizia; Talia, Michela; Torres, Daniele; Traversa, Metteo; Vazzana, Natale; Rita Vecchio Claudia, Claudia; Vettore, Elia; Vitale., Francesco
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