Meet the Experts: Management of coagulation changes in patients with liver disease undergoing an invasive procedure

 General hepatology
 Imaging and interventional

Stolz 2
Meet the Experts
12 April 2019 11:30 - 12:20

Questions for discussion: 

One of the 5 items on the 2014 ‘Choosing Wisely’ list published by the AASLD is “Don’t routinely transfuse fresh frozen plasma and platelets prior to abdominal paracentesis or endoscopic variceal band ligation.” Do you adhere to this advice?

  • If so, what would be a reason to transfuse FFP or platelets prior to abdominal paracentesis or endoscopic variceal band ligation?
  • How large do you estimate the bleeding risk in patients undergoing abdominal paracentesis, endoscopic variceal band ligation, or liver biopsy?
  • Do you avoid or delay endoscopic variceal band ligation in patients on LMWH?
  • Would you perform major surgery in a patient with cirrhosis and a substantially prolonged INR and moderate thrombocytopenia (INR 1,7; 48.000 platelets/μl)?
  • In patients with cirrhosis undergoing an invasive procedure who have a prolonged INR and or are thrombocytopenic, do you perform TEG or ROTEM prior to the procedure?
  • Do you administer thromboprophylaxis to patients with cirrhosis following a major invasive procedure or during prolonged immobilization?
  • Do you require a bleeding history in a patient with cirrhosis prior to an invasive procedure?
  • Do you consider factor concentrates as an alternative to FFP in prevention of procedural bleeding in a patient with cirrhosis?