Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines

Table 1 Threshold of platelet count before percutaneous liver biopsy: evolution of the guidelines

Society	Year	Bleeding risk	Platelet count threshold (/μL)	Ref.
National Institute for Health and Care Excellence	2015	Not classified	50000	National Clinical Guideline Centre (UK)[43]
British Committee for Standards in Haematology	2016	Not classified	50000	Estcourt et al[37]
Italian Association for the Study of Liver Diseases and the Italian Society of Internal Medicine	2016	Low	50000 “this recommendation is supported only by biological plausibility”	Under the auspices of the Italian Association for the Study of Liver Diseases (AISF) and the Italian Society of Internal Medicine (SIMI)[42]
International Coagulation in Liver Disease	2017	Intermediate	“Generally not recommended”	Intagliata et al[30]
American Gastroenterological Association	2019	Intermediate	50000	O'Leary et al[44]
Society of Interventional Radiology	2019	High	50000 (20000 for transjugular liver biopsy)	Patel et al[31]
American Association for the Study of Liver Diseases	2020	High	“Suggest individualized approaches”	Northup et al[47]
American College of Gastroenterology	2020	Not classified	Correction not recommended	Simonetto et al[45]
International Society on Thrombosis and Haemostasis	2021	High	Do not correct	Roberts et al[46]
American Gastroenterological Association	2021	High	“Suggests against the preprocedural testing”	O'Shea et al[48]
European Association for the Study of the Liver	2022	Low	“Cannot be generally indicated”	European Association for the Study of the Liver[49]

Table 2 Threshold of platelet count before esophageal variceal band ligation: evolution of the guidelines

Society	Year	Bleeding risk	Platelet count threshold (/μL)	Ref.
American Society for Gastrointestinal Endoscopy	2014	Not classified	“Not recommended”	ASGE Standards of Practice Committee et al[61]
National Institute for Health and Care Excellence	2015	Not classified	50000	National Clinical Guideline Centre (UK)[43]
American Association for the Study of Liver Diseases	2016	Not classified	“Not provided a recommendation”	Garcia-Tsao et al[70]
Italian Association for the Study of Liver Diseases and the Italian Society of Internal Medicine	2016	Moderate	50000 “this recommendation is supported only by biological plausibility”	Under the auspices of the Italian Association for the Study of Liver Diseases (AISF) and the Italian Society of Internal Medicine (SIMI)[42]
Austrian Society of Gastroenterology and Hepatology and the Austrian Society of Interventional Radiology	2017	Not classified	50000	Reiberger et al[71]
International Coagulation in Liver Disease	2017	Low	“Generally not recommended”	Intagliata et al[30]
American Gastroenterological Association	2019	Low	“Prophylaxis not required, although the authors recognize that risk assessment will vary in the clinical context”	O'Leary et al[44]
American Association for the Study of Liver Diseases	2020	Low	“Suggest individualized approaches”	Northup et al[47]
American College of Gastroenterology	2020	Not classified	Correction not recommended	Simonetto et al[45]
International Society on Thrombosis and Haemostasis	2021	Low	Do not correct	Roberts et al[46]
American Gastroenterological Association	2021	Low	“Suggests against the preprocedural testing”	O'Shea et al[48]
European Association for the Study of the Liver	2022	High	“Generally not indicated”	European Association for the Study of the Liver[49]

Table 3 Threshold of platelet count before trans-arterial chemoembolization: Evolution of the guidelines

Society	Year	Bleeding risk	Platelet count threshold (/μL)	Ref.
National Institute for Health and Care Excellence	2015	Not classified	50000	National Clinical Guideline Centre (UK)[43]
International Coagulation in Liver Disease	2017	Intermediate	“Generally not recommended”	Intagliata et al[30]
American Association for the Study of Liver Diseases	2020	High	“Suggest individualized approaches”	Northup et al[47]
International Society on Thrombosis and Haemostasis	2021	High	Do not correct	Roberts et al[46]
European Association for the Study of the Liver	2022	Low	“Cannot be generally indicated”	European Association for the Study of the Liver[49]