Managing bleeding risk in patients with cirrhosis undergoing a procedure

In patients with cirrhosis undergoing routine procedures with a low bleeding risk (eg paracentesis, elective endoscopy with or without variceal banding), correction of laboratory markers of coagulation (international normalised ratio [INR], prothrombin time [PT]) with blood products is generally not recommended. Apart from the usual risks associated with transfusion of blood products, they can also increase portal pressure as a result of plasma volume expansion.

Note: For routine procedures with a low bleeding risk, correction of laboratory coagulation values with blood products is generally not recommended.

For procedures with a higher bleeding risk, or for patients with active bleeding, consult local protocols. Correction of thrombocytopenia (aiming for a platelet count of more than 50 × 109/L) and hypofibrinogenaemia may be required; assess patients on a case-by-case basis.O'Leary 2019Patel 2019Northup AASLD 2021