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

Granito Alessandro;Pettinari Irene;Marinelli Sara;Bolondi Luigi;Falsetti Lorenzo;Riccardi Laura;Vidili Gianpaolo;Invernizzi Pietro;Serra Carla;
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.
S Basili; V Raparelli; L Napoleone; G Talerico; G Corazza; F Perticone; D Sacerdoti; A Andriulli; A Licata; A Pietrangelo; A Picardi; G Raimondo; F Violi; MD on behalf of PRO-LIVER Collaborators; Palasciano Giuseppe; D’Alitto Felicia; Palmieri Vincenzo Ostilio; Santovito Daniela; Di Michele Dario; Croce Giuseppe; Brocco Silvia; Fasolato Silvano; Cecchetto Lara; Bombonato Giancarlo; Bertoni Michele; Restuccia Tea; Andreozzi Paola; Liguori Maria Livia; 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 Vincenza; 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; Davi Giovanni; Schiavone Cosima; Santilli Francesca; Tana Claudio; Soresi Maurizio; Bianchi Giovanni Battista; Carderi Isabella; Pinto Antonio; Tuttolomondo Antonino; Ferrari Giovanni; Gresele Paolo; Fierro Tiziana; Morelli Olivia; Laffi Giacomo; Romanelli Roberto Giulio; Arena Umberto; Stasi Cristina; Gasbarrini Antonio; Garcovich Matteo; Zocco Maria Assunta; Riccardi Laura; Ainora Maria Elena; Capeci William; Martino Giuseppe Pio; 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; Vincenzo Ronca; Di Minno Giovanni; Tufano Antonella; Purrello Francesco; Privitera Graziella; Forgione Alessandra; Curigliano Valentina; Senzolo Marco; Rodríguez-Castro Kryssia Isabel; Giannelli Gianluigi; Serra Carla; Neri Sergio; Pignataro Pietro; Rizzetto Mario; Debernardi Venon Wilma; Svegliati Baroni Gianluca; Bergamaschi Gaetano; Masotti Michela; Costanzo Filippo; Antonio Figliomeni; Angelico Francesco; Del Ben Maria; Polimeni Licia; Proietti Marco; Cangemi Roberto; Romiti Giulio Francesco; Toriello Filippo; Sperduti Nicolò; Santangelo Giuseppe; Visioli Giacomo; Todisco Tommaso; Vestri Anna Rita; Farcomeni Alessio; Corrao Salvatore; Gobbi Paolo; Corradini Elena; Costantino Giorgio; Tripepi Giovanni; Angelico Mario; D’Amico Gennaro; de Franchis Roberto; Gatta Angelo; Tassone Eliezer Joseph; Anzaldi Massimiliano; Barone Milena; Bazzini Cristina; Bianchi Paola Ilaria; Boari Benedetta; Bracco Christian; Buonauro Agostino; Buttà Carmelo; Buzzetti Elena; Calabria Stefano; Caradio Federica; Carleo Pietro; Carrabba Maria Domenica; Castorani Luigi; Cecchetto Lara; Cicco Sebastiano; Cimini Claudia; Colombo Barbara Maria; De Giorgi Alfredo; 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; Marra Alberto Maria; Masala Maristella; Miceli Giuseppe; Montebianco Abenavoli Ludovico; Murgia Giuseppe; Naccarato Paola; Padula Donatella; Pattoneri Paolo; Perego Francesca; Pesce Paola; Petramala Luigi; Piano Salvatore; Pinto Daniela; Pinna Miriam; Pignataro Francesca Serena; Pretti Vincenzo; Pucci Giacomo; Salinaro Francesco; Salzano Andrea; Santarossa Claudia; Scarpini Francesca; Scicali Roberto; Sirico Domenico; Suppressa Patrizia; Talia Michela; Torres Daniele; Traversa Matteo; Vazzana Natale; Vecchio Claudia Rita; Vettore Elia; Vitale Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/632508
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