A Prospective Study of Conventional and Expanded Coagulation Indices in Predicting Ulcer Bleeding After Variceal Band Ligation

  • Vieira da Rocha E
  • D'Amico E
  • Caldwell S
 et al. 
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Background & Aims: There is controversy over whether coagulation status predicts bleeding caused by ulceration after esophageal varices band ligation (EVL). Methods: EVL was performed for primary (n = 45) or secondary (n = 105) prophylaxis in 150 patients with cirrhosis (Child A, n = 74, 49%; Child B, n = 42, 28%; Child C, n = 34, 23%). International normalized ratio (INR) and platelet counts were assessed in all. In 92 patients, levels of factor V, fibrinogen, D-dimer, protein C and protein S, von Willebrand factor, and thromboelastography (TEG) were assessed. Platelet count 1.5 were considered high-risk cutoff for bleeding. Conversely, platelet count ≥50 × 103/mm3with INR ≤1.5 were safe cutoffs. Results: Overall, 11 patients (7.3%) had post-EVL ulcer bleeding. Bleeding occurred in 5 patients with Child A/B (4.3%) and 6 patients with Child C (17%) (P = .0174 for Child A/B versus Child C). Eight patients with bleeding were among the 110 below the cutoff for INR and platelet count, whereas only 3 of the patients with bleeding were among the 40 patients with purported high-risk values (P = 1.0). Among the 92 patients with expanded coagulation tests, bleeding occurred in 5. There was no difference in any of the coagulation parameters, including overall TEG patterns, between patients who did and did not bleed. Conclusions: Post-EVL ulcer bleeding was associated with Child C status but not with conventional or expanded coagulation indices in cirrhotic patients without renal failure or infection undergoing elective EVL. These results call into question the common use of prophylactic procoagulants in the elective setting. © 2009 AGA Institute.

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  • Evandra Cristina Vieira da Rocha

  • Elbio Antonio D'Amico

  • Stephen Hugh Caldwell

  • Tania Rubia Flores da Rocha

  • Cristina Simões Solon Soares E Silva

  • Valdinelia Dos Santos Bomfim

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