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Platelet Count Does Not Predict Bleeding in Cirrhotic Patients: Results from the PRO-LIVER Study

Basili, S MD1; Raparelli, V MD, PhD2; Napoleone, L MD2; Talerico, G MD1; Corazza, G R MD3; Perticone, F MD4; Sacerdoti, D MD5; Andriulli, A MD6; Licata, A MD7; Pietrangelo, A MD8; Picardi, A MD9; Raimondo, G MD10; Violi, F MD1 on behalf of PRO-LIVER Collaborators

American Journal of Gastroenterology: March 2018 - Volume 113 - Issue 3 - p 368–375
doi: 10.1038/ajg.2017.457

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.

1Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

2Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

3Clinica Medica I, Department of Internal Medicine S. Matteo, University Hospital Pavia, Pavia, Italy

4Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy

5Department of Medicine, University of Padova, Padova, Italy

6Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy

7Department of Internal Medicine and Specialities, DIBIMIS, University of Palermo, Palermo, Italy

8Unit of Internal Medicine 2, Department of Medical and Surgical Science for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy

9Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Rome, Italy

10Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

Correspondence: F. Violi, MD, Clinica Medica I, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy. E-mail:

11The PRO-LIVER Collaborators are listed above the References

published online 19 December 2017

Received 20 April 2017; accepted 6 November 2017

© The American College of Gastroenterology 2018. All Rights Reserved.
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