PO033 | PLATELET COUNT AND PERIPROCEDURAL MAJOR BLEEDING IN CIRRHOTIC PATIENTS UNDERGOING INVASIVE PROCEDURES: INDIVIDUAL PATIENT DATA META-ANALYSIS
Abstract
Background and Aims. Cirrhotic patients have a fragile hemostatic balance, which can be perturbed by invasive procedures. Thrombocytopenia is often feared because of the risk of periprocedural bleeding and some guidelines recommend platelet transfusion for counts below 50x109/L. However, evidence supporting this practice remains conflicting. We performed an individual patient data meta-analysis to evaluate the impact of the platelet count on periprocedural bleeding in cirrhotic patients undergoing invasive procedures. Methods. We searched Medline and Embase for randomized controlled trials and prospective and cohort studies published between 2010 and 2021 using a pre-defined research string. We included studies in English reporting on periprocedural major bleeding (ISTH definition) and post-procedural mortality in adult patients with cirrhosis undergoing laparotomic, laparoscopic or percutaneous procedures. Patients undergoing endoscopic or endovascular procedures and those receiving thrombopoietin receptor agonists were excluded. Eligible procedures were classified as high- or low-bleeding risk according to predefined criteria. Individual patient data (including platelet counts) were requested from study authors. The primary outcome of this study was the prevalence of periprocedural major bleeding. Results. Of 585 retrieved citations, we included 9 studies, resulting in 2747 cirrhotic patients who underwent a total of 3136 eligible procedures. Eligible patients were stratified based on their platelet counts: less than 50x109/L (n=394), 50 to 99x109/L (n=969), and 100x109/L or more (n=1384). Of the eligible procedures, 2135 (68%) were classified at high bleeding risk. Overall, the prevalence of periprocedural major bleeding was 8% (243/3136). Stratifying patients by platelet count, the prevalence of periprocedural major bleeding was 8% (34/416) in patients with counts <50x109/L, 9% (94/1102) in patients with counts between 50 and 99x109/L and 7% (115/1618) in patients with counts ≥100 x109/L, with no statistically significant differences across the groups (p=0.37). Stratifying the procedures based on their inherent bleeding risk, periprocedural major bleeding was significantly more prevalent in high-risk procedures (11%, 224/2135) than in low-risk procedures (2%, 19/1001) (p<0.001). The prevalence of major bleeding related to high-risk procedures did not significantly differ across platelet count groups (p=0.16). Periprocedural major bleeding occurred in 8 of 85 (9%) patients who received prophylactic platelet transfusions and in 103 of 2020 (5%) patients who did not, with no statistically significant differences between transfused and non-transfused patients (p=0.14) nor across platelet count groups (transfused and non-transfused patients: p=0.94 and p=0.40, respectively). Conclusions. The results of this individual patient data meta-analysis show that cirrhotic patients’ platelet counts and prophylactic platelet transfusion practices were not associated with the rates of periprocedural major bleeding. The type of invasive procedure and its inherent bleeding risk emerged as the clinical covariates most strongly associated with the occurrence of major bleeding, suggesting that bleeding risk assessment should be based on the procedure type and feasibility of local hemostasis, rather than on platelet counts alone.
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BibTeX
@article{tarasconi2026po033,
title = {{PO033 | PLATELET COUNT AND PERIPROCEDURAL MAJOR BLEEDING IN CIRRHOTIC PATIENTS UNDERGOING INVASIVE PROCEDURES: INDIVIDUAL PATIENT DATA META-ANALYSIS}},
author = {Elisa Tarasconi},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/849},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - PO033 | PLATELET COUNT AND PERIPROCEDURAL MAJOR BLEEDING IN CIRRHOTIC PATIENTS UNDERGOING INVASIVE PROCEDURES: INDIVIDUAL PATIENT DATA META-ANALYSIS
AU - Elisa Tarasconi
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/849
AB - Background and Aims. Cirrhotic patients have a fragile hemostatic balance, which can be perturbed by invasive procedures. Thrombocytopenia is often feared because of the risk of periprocedural bleeding and some guidelines recommend platelet transfusion for counts below 50x109/L. However, evidence supporting this practice remains conflicting. We performed an individual patient data meta-analysis to evaluate the impact of the platelet count on periprocedural bleeding in cirrhotic patients undergoing invasive procedures. Methods. We searched Medline and Embase for randomized controlled trials and prospective and cohort studies published between 2010 and 2021 using a pre-defined research string. We included studies in English reporting on periprocedural major bleeding (ISTH definition) and post-procedural mortality in adult patients with cirrhosis undergoing laparotomic, laparoscopic or percutaneous procedures. Patients undergoing endoscopic or endovascular procedures and those receiving thrombopoietin receptor agonists were excluded. Eligible procedures were classified as high- or low-bleeding risk according to predefined criteria. Individual patient data (including platelet counts) were requested from study authors. The primary outcome of this study was the prevalence of periprocedural major bleeding. Results. Of 585 retrieved citations, we included 9 studies, resulting in 2747 cirrhotic patients who underwent a total of 3136 eligible procedures. Eligible patients were stratified based on their platelet counts: less than 50x109/L (n=394), 50 to 99x109/L (n=969), and 100x109/L or more (n=1384). Of the eligible procedures, 2135 (68%) were classified at high bleeding risk. Overall, the prevalence of periprocedural major bleeding was 8% (243/3136). Stratifying patients by platelet count, the prevalence of periprocedural major bleeding was 8% (34/416) in patients with counts <50x109/L, 9% (94/1102) in patients with counts between 50 and 99x109/L and 7% (115/1618) in patients with counts ≥100 x109/L, with no statistically significant differences across the groups (p=0.37). Stratifying the procedures based on their inherent bleeding risk, periprocedural major bleeding was significantly more prevalent in high-risk procedures (11%, 224/2135) than in low-risk procedures (2%, 19/1001) (p<0.001). The prevalence of major bleeding related to high-risk procedures did not significantly differ across platelet count groups (p=0.16). Periprocedural major bleeding occurred in 8 of 85 (9%) patients who received prophylactic platelet transfusions and in 103 of 2020 (5%) patients who did not, with no statistically significant differences between transfused and non-transfused patients (p=0.14) nor across platelet count groups (transfused and non-transfused patients: p=0.94 and p=0.40, respectively). Conclusions. The results of this individual patient data meta-analysis show that cirrhotic patients’ platelet counts and prophylactic platelet transfusion practices were not associated with the rates of periprocedural major bleeding. The type of invasive procedure and its inherent bleeding risk emerged as the clinical covariates most strongly associated with the occurrence of major bleeding, suggesting that bleeding risk assessment should be based on the procedure type and feasibility of local hemostasis, rather than on platelet counts alone.
SN - 2785-5309
ER -