Usefulness of International Normalized Ratio to Predict Bleeding Complications in Patients with End-stage Liver Disease Who Undergo Cardiac Catheterization

摘要

Patients with end-stage liver disease frequently need invasive cardiac procedures in preparation for liver transplantation. As a consequence of impaired hepatic function these patients often have a prolonged prothrombin time (PT) and elevated International Normalized Ratio (INR). To determine whether an abnormal PT/INR is predictive of bleeding complications from invasive cardiac procedures, we reviewed retrospectively, for bleeding complications, the databases and case records of our series of patients with advanced cirrhosis who underwent cardiac catheterization. One hundred and fifty-seven patients underwent isolated right heart catheterization (RHC), and 83 underwent left (LHC) or combined left and right sided heart catheterization. INRs ranged from 0.93-2.35. There were no major procedure-related complications. Several patients in each group required blood transfusion for gastrointestinal bleeding, but not for procedure-related bleeding. There was no significant change in hemoglobin after RHC or LHC, and no correlation between pre-procedure INR and change in post-procedure hemoglobin. When comparing patients with normal (≤1.5) and elevated (>1.5) INRs, no significant difference in hemoglobin post-procedure was found in either group. In conclusion, despite an elevated INR, patients with end-stage liver disease can safely undergo invasive cardiac procedures. INR elevation does not predict catheterization-related bleeding complications in this patient population.