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.

Original languageEnglish
Pages (from-to)368-375
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume113
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Platelet Count
Hemorrhage
Liver Diseases
Confidence Intervals
International Normalized Ratio
Prothrombin Time
Brain Diseases
Thrombocytopenia
Fibrosis
Observation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Platelet count does not predict bleeding in cirrhotic patients : Results from the PRO-LIVER Study. / PRO-LIVER Collaborators.

In: American Journal of Gastroenterology, Vol. 113, No. 3, 01.03.2018, p. 368-375.

Research output: Contribution to journalArticle

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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.",
author = "{PRO-LIVER Collaborators} and S. Basili and V. Raparelli and L. Napoleone and G. Talerico and Corazza, {G. R.} and F. Perticone and D. Sacerdoti and A. Andriulli and A. Licata and A. Pietrangelo and A. Picardi and G. Raimondo and F. Violi and Giuseppe Palasciano and Felicia D’Alitto and Palmieri, {Vincenzo Ostilio} and Daniela Santovito and {Di Michele}, Dario and Giuseppe Croce and Silvia Brocco and Silvano Fasolato and Lara Cecchetto and Giancarlo Bombonato and Michele Bertoni and Tea Restuccia and Paola Andreozzi and Liguori, {Maria Livia} and Benedetto Caroleo and Maria Perticone and Orietta Staltari and Sara Marinelli and Antonio Ippolito and Angelo Iacobellis and Grazia Niro and Antonio Merla and Antonio Pinto and Antonio Greco and Pietro Invernizzi and Alessandra Forgione and Gianluigi Giannelli and Mario Rizzetto and Gaetano Bergamaschi and Paolo Gobbi and Giorgio Costantino and Bianchi, {Paola Ilaria} and Christian Bracco and {Carrabba Maria}, Domenica and Colombo, {Barbara Maria} and Alessandra Marchese and Miriam Pinna",
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T1 - Platelet count does not predict bleeding in cirrhotic patients

T2 - Results from the PRO-LIVER Study

AU - PRO-LIVER Collaborators

AU - Basili, S.

AU - Raparelli, V.

AU - Napoleone, L.

AU - Talerico, G.

AU - Corazza, G. R.

AU - Perticone, F.

AU - Sacerdoti, D.

AU - Andriulli, A.

AU - Licata, A.

AU - Pietrangelo, A.

AU - Picardi, A.

AU - Raimondo, G.

AU - Violi, F.

AU - Palasciano, Giuseppe

AU - D’Alitto, Felicia

AU - Palmieri, Vincenzo Ostilio

AU - Santovito, Daniela

AU - Di Michele, Dario

AU - Croce, Giuseppe

AU - Brocco, Silvia

AU - Fasolato, Silvano

AU - Cecchetto, Lara

AU - Bombonato, Giancarlo

AU - Bertoni, Michele

AU - Restuccia, Tea

AU - Andreozzi, Paola

AU - Liguori, Maria Livia

AU - Caroleo, Benedetto

AU - Perticone, Maria

AU - Staltari, Orietta

AU - Marinelli, Sara

AU - Ippolito, Antonio

AU - Iacobellis, Angelo

AU - Niro, Grazia

AU - Merla, Antonio

AU - Pinto, Antonio

AU - Greco, Antonio

AU - Invernizzi, Pietro

AU - Forgione, Alessandra

AU - Giannelli, Gianluigi

AU - Rizzetto, Mario

AU - Bergamaschi, Gaetano

AU - Gobbi, Paolo

AU - Costantino, Giorgio

AU - Bianchi, Paola Ilaria

AU - Bracco, Christian

AU - Carrabba Maria, Domenica

AU - Colombo, Barbara Maria

AU - Marchese, Alessandra

AU - Pinna, Miriam

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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.

AB - 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.

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