Management of Thrombocytopenia and Coagulopathy in Patients with Chronic Liver Disease Undergoing Therapeutic Endoscopic Interventions

The understanding of hemostasis in patients with cirrhosis is evolving. For this reason, the evaluation of a patient with advanced liver disease before endoscopy requires careful attention to clinical circumstance. As previously discussed, bleeding risk in patients with cirrhosis depends on multiple factors, including the severity of liver disease, presence of coexisting systemic diseases known to accentuate bleeding risk, presence of portal hypertension, and type of procedure being performed. Any approach to the management of patients that attempts to reduce the bleeding risk in patients with advanced liver disease before endoscopy should address these factors. The authors agree with the recommendation of the professional societies that in no clinical scenario should FFP be administered to lower the INR before endoscopy, given the lack of efficacy and potential complications associated with administration of FFP, including transfusion-related syndromes and circulatory overload.