Abstract Number: OC 13.4
Meeting: ISTH 2020 Congress
Background: It has been recommended to increase the platelet count with platelet transfusions in cirrhotic patients undergoing invasive procedures when their platelet count is lower than 50×109/L, in order to reduce the risk of major peri-procedural bleeding. This recommendation mostly stemmed from considerations on biological plausibility by experts, rather than being based on hard experimental evidence.
Aims: to investigate the association between platelet count and peri-operative bleeding in a relatively large cohort of cirrhotic patients who underwent excision of hepatocellular carcinoma without prophylactic platelet transfusions.
Methods: We retrospectively evaluated 996 patients who underwent surgical excision of hepatocellular carcinoma by hepatic resection or radiofrequency ablation between 1998 and 2018 (table). Patients were allocated to three different groups based on their platelet count:
Group 1, >100 x109/L;
Group 2, 50-100×109/L;
Group 3, < 50x109/L.
The primary endpoint was peri-surgical major bleeding, based on the criteria of the ISTH. Data were analyzed by relative risk regression analysis.
Results: The overall event rate of perioperative bleeding was 8.9%; there was no statistically significant difference among the 3 groups of patients: Group 1=8%; Group 2=10%; Group 3=11% (p=n.s.). By multivariate analysis, increased incidence of major bleeding was significantly associated with the following factors: low hemoglobin level (RR 0.63, CI 0.57-0.69), age>65 years (RR 1.67, IC 0.97-2.89) and hepatic resection versus radiofrequency ablation
(RR 2.78, CI 1.86-4.16).
Conclusions: Peri-operative bleeding was not influenced by platelet count in cirrhotic patients undergoing excision of hepatocellular carcinoma without prophylactic platelet transfusions, even when the platelet count was < 50×109/L. Our data do not support the recommendation of transfusing platelet concentrates in patients with platelet counts < 50×109/L in order to decrease their peri-operative bleeding risk.
To cite this abstract in AMA style:Ronca V, Podda G, Santambrogio R, Barabino M, Opocher E, Battezzati PM, Zuin M, Cattaneo M. The Association between Platelet Count and Perioperative Bleeding Complication in a Cohort of Cirrhotic Patients Undergoing Surgical Excision of Hepatocellular Carcinoma [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-association-between-platelet-count-and-perioperative-bleeding-complication-in-a-cohort-of-cirrhotic-patients-undergoing-surgical-excision-of-hepatocellular-carcinoma/. Accessed October 26, 2020.
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