Biolato M, Vitale F, Galasso T, Gasbarrini A, Grieco A. Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines. World J Gastrointest Surg 2023; 15(2): 127-141 [PMID: 36896308 DOI: 10.4240/wjgs.v15.i2.127]
Corresponding Author of This Article
Marco Biolato, MD, PhD, Staff Physician, Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy. marco.biolato@policlinicogemelli.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2023; 15(2): 127-141 Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.127
Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines
Marco Biolato, Federica Vitale, Tiziano Galasso, Antonio Gasbarrini, Antonio Grieco
Marco Biolato, Antonio Gasbarrini, Antonio Grieco, Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Marco Biolato, Federica Vitale, Tiziano Galasso, Antonio Gasbarrini, Antonio Grieco, Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
Author contributions: Biolato M and Vitale F wrote the paper; Galasso T prepared the tables; Gasbarrini A and Grieco A revised the paper for important intellectual content; All authors read and approved the final manuscript.
Conflict-of-interest statement: Biolato M and Grieco A received personal fees from SOBI s.r.l. and Shionogi B.V. Other authors declare no conflict of interests relevant to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Biolato, MD, PhD, Staff Physician, Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy. marco.biolato@policlinicogemelli.it
Received: September 27, 2022 Peer-review started: September 27, 2022 First decision: October 30, 2022 Revised: December 9, 2022 Accepted: February 7, 2023 Article in press: February 7, 2023 Published online: February 27, 2023
Abstract
Cirrhotic patients with severe thrombocytopenia are at increased risk of bleeding during invasive procedures. The need for preprocedural prophylaxis aimed at reducing the risk of bleeding in cirrhotic patients with thrombocytopenia who undergo scheduled procedures is assessed via the platelet count; however, establishing a minimum threshold considered safe is challenging. A platelet count ≥ 50000/μL is a frequent target, but levels vary by provider, procedure, and specific patient. Over the years, this value has changed several times according to the different guidelines proposed in the literature. According to the latest guidelines, many procedures can be performed at any level of platelet count, which should not necessarily be checked before the procedure. In this review, we aim to investigate and describe how the guidelines have evolved in recent years in the evaluation of the minimum platelet count threshold required to perform different invasive procedures, according to their bleeding risk.
Core Tip: There are several reviews in the literature that deals with the management of thrombocytopenia in patients with cirrhosis undergoing scheduled invasive procedures. However, this review is one of the few to provide a comparison between the main guidelines concerning the platelet-count reference threshold to consider safely performing the various types of procedures.
