Transfusing Common Sense Instead of Blood Products Into Coagulation Testing in Patients With Cirrhosis: Overtreatment - Safety

摘要

In patients with cirrhosis the imbalance of procoagu-lants and anticoagulants combined with potential alterations in fibrinolysis and platelet number and function can alter standard laboratory coagulation testing. Prothrombin time and platelet count are frequently abnormal and, in our risk-averse health care system, often result in preprocedure transfusions to achieve "safer" thresholds. But what are we actually achieving: a risk of portal hypertensive bleeding, transfusion reaction, transfusion-related acute lung injury, infection transmission, human leukocyte antigen (HLA) antibody development, superior test results, or improved coagulation?According to the International Symposium on Coagul-opathy and Liver Disease, rebalanced hemostasis is what we need to measure, which stems from both the prohe-mostatic and antihemostatic pathways working in concert. Disproportionately fewer nonportal hypertension-related bleeding complications occur in patients with cirrhosis relative to their prothrombin time and platelet values. This results from relatively rebalanced hemostasis. Despite this, many health care professionals continue to transfuse blood products (i.e., fresh frozen plasma [FFP] and platelets) prophylactically to improve laboratory profiles, regardless of function and prior data demonstrating a low risk of bleeding complications in patients with cirrhosis, especially for minimally invasive procedures like paracentesis.