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 / Basili, S.; Raparelli, V.; Napoleone, L.; Talerico, G.; Corazza, G. R.; Perticone, F.; Sacerdoti, D.; Andriulli, A.; Licata, A.; Pietrangelo, A.; Picardi, A.; Guidacci, Raimondo; Violi, F.; Palasciano, G.; D'Alitto, F.; Palmieri, V. O.; Santovito, D.; Di Michele, D.; Croce, G.; Brocco, S.; Fasolato, S.; Cecchetto, L.; Bombonato, G.; Bertoni, M.; Restuccia, T.; Andreozzi, P.; Liguori, M. L.; Caroleo, B.; Perticone, M.; Staltari, O.; Manfredini, R.; De Giorgi, A.; Averna, M.; Giammanco, A.; Granito, A.; Pettinari, I.; Marinelli, S.; Bolondi, L.; Falsetti, L.; Salvi, A.; Durante-Mangoni, E.; Cesaro, F.; Farinaro, V.; Ragone, E.; Morana, I.; Ippolito, A.; Iacobellis, A.; Niro, G.; Merla, A.; Maimone, S.; Cacciola, I.; Varvara, D.; Drenaggi, D.; Staffolani, S.; Vespasiani-Gentilucci, U.; Galati, G.; Gallo, P.; Davi, G.; Schiavone, C.; Santilli, F.; Tana, C.; Soresi, M.; Bianchi Giovanni, B.; Carderi, I.; Pinto, A.; Tuttolomondo, A.; Ferrari, G.; Gresele, P.; Fierro, T.; Morelli, O.; Laffi, G.; Romanelli, R. G.; Arena, U.; Stasi, C.; Gasbarrini, A.; Garcovich, M.; Zocco, M. A.; Riccardi, L.; Ainora, M. E.; Capeci, W.; Martino Giuseppe, P.; Nobili, L.; Cavallo, M.; Frugiuele, P.; Greco, A.; Ventura, P.; Cuoghi, C.; Marcacci, M.; Serviddio, G.; Vendemiale, G.; Villani, R.; Gargano, R.; Vidili, G.; Di Cesare, V.; Masala, M.; Delitala, G.; Invernizzi, P.; Vincenzo, R.; Di Minno, G.; Tufano, A.; Purrello, F.; Privitera, G.; Forgione, A.; Curigliano, V.; Senzolo, M.; Rodriguez-Castro, K. I.; Giannelli, G.; Serra, C.; Neri, S.; Pignataro, P.; Rizzetto, M.; Debernardi, V. W.; Svegliati, B. G.; Bergamaschi, G.; Masotti, M.; Costanzo, F.; Antonio, F.; Angelico, F.; Del Ben, M.; Polimeni, L.; Proietti, M.; Cangemi, R.; Romiti, G. F.; Toriello, F.; Sperduti, N.; Santangelo, G.; Visioli, G.; Todisco, T.; Vestri Anna, R.; Farcomeni, A.; Corrao, S.; Gobbi, P.; Corradini, E.; Costantino, G.; Tripepi, G.; Angelico, M.; D'Amico, G.; De Franchis, R.; Gatta, A.; Tassone, E. J.; Anzaldi, M.; Barone, M.; Bazzini, C.; Bianchi, P. I.; Boari, B.; Bracco, C.; Buonauro, A.; Butta, C.; Buzzetti, E.; Calabria, S.; Caradio, F.; Carleo, P.; Carrabba Maria, D.; Castorani, L.; Cicco, S.; Cimini, C.; Colombo, B. M.; De Vuono, S.; Denegri, A.; Del Corso, L.; Di Giosia, P.; Donnarumma, E.; Giorgini, P.; Grassi, D.; Grembiale, A.; Hijazi, D.; Iamele, L.; Lorusso, G.; Marchese, A.; Marra, A. M.; Miceli, G.; Montebianco, A. L.; Murgia, G.; Naccarato, P.; Padula, D.; Pattoneri, P.; Perego, F.; Pesce, P.; Petramala, L.; Piano, S.; Pinto, D.; Pinna, M.; Pignataro, F. S.; Pretti, V.; Pucci, G.; Salinaro, F.; Salzano, A.; Santarossa, C.; Scarpini, F.; Scicali, R.; Sirico, D.; Suppressa, P.; Talia, M.; Torres, D.; Traversa, M.; Vazzana, N.; Vecchio Claudia, R.; Vettore, E.; Vitale, F.. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - 113:3(2018), pp. 368-375. [10.1038/ajg.2017.457]
Platelet count does not predict bleeding in cirrhotic patients: Results from the PRO-LIVER Study
Raimondo G.;Bertoni M.;Andreozzi P.;Liguori M. L.;Averna M.;Giammanco A.;Marinelli S.;Farinaro V.;Galati G.;Ventura P.;Serviddio G.;Di Minno G.;Tufano A.;Purrello F.;Neri S.;Pignataro P.;Masotti M.;Del Ben M.;Proietti M.;Costantino G.;D'Amico G.;Gatta A.;Buonauro A.;Butta C.;Marchese A.;Marra A. M.;Miceli G.;Pesce P.;Piano S.;Pinna M.;Pucci G.;Sirico D.;
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
