肝硬化患者凝血功能障碍与侵入性操作后出血风险的相关性
Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis.
作者信息
Li Jing, Han Bing, Li Hongyu, Deng Han, Méndez-Sánchez Nahum, Guo Xiaozhong, Qi Xingshun
机构信息
Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning Province, China.
Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang; Postgraduate College, Jinzhou Medical University, Jinzhou, Liaoning Province, China.
出版信息
Saudi J Gastroenterol. 2018 Jul-Aug;24(4):220-227. doi: 10.4103/sjg.SJG_486_17.
BACKGROUND/AIM: Bleeding risk among patients with acute or chronic liver disease after invasive procedures is a common concern in clinical practice. This retrospective study aimed to explore whether the presence of coagulopathy increased the risk of major bleeding after invasive procedures in cirrhosis.
PATIENTS AND METHODS
A total of 874 cirrhotic patients underwent invasive procedures. Coagulopathy was defined as international normalized ratio (INR) ≥1.5 and/or platelets (PLTs) ≤50 × 10/L. Severe thrombocytopenia was defined as PLTs ≤ 50 × 10/L. Invasive procedures, major bleeding after invasive procedures, and in-hospital deaths were recorded.
RESULTS
In all, 296 patients (33.9%) had coagulopathy. Major bleeding after invasive procedures occurred in 21 patients (2.4%). Major bleeding after invasive procedures was more frequent in patients with coagulopathy than those without coagulopathy (4.1% vs 1.6%, P = 0.023). Major bleeding after invasive procedures was more frequent in patients with severe thrombocytopenia than those without severe thrombocytopenia (4.9% vs 1.6%, P = 0.008). Incidence of major bleeding after invasive procedures was not significantly different between patients with INR ≥ 1.5 and INR < 1.5 (4.5% vs 2.0%, P = 0.065). Patients with INR ≥1.5 had a significantly higher in-hospital mortality than those with INR < 1.5 (6.4% vs 1.3%, P < 0.001).
CONCLUSION
Severe thrombocytopenia significantly increased the risk of major bleeding after invasive procedures in cirrhosis. INR ≥ 1.5 significantly increased in-hospital mortality.
背景/目的：急性或慢性肝病患者在进行侵入性操作后的出血风险是临床实践中常见的关注点。这项回顾性研究旨在探讨凝血病的存在是否会增加肝硬化患者在侵入性操作后发生大出血的风险。
患者与方法
共有874例肝硬化患者接受了侵入性操作。凝血病定义为国际标准化比值（INR）≥1.5和/或血小板（PLT）≤50×10⁹/L。严重血小板减少症定义为PLT≤50×10⁹/L。记录侵入性操作、侵入性操作后的大出血情况及住院死亡情况。
结果
总共有296例患者（33.9%）患有凝血病。侵入性操作后大出血发生在21例患者（2.4%）中。凝血病患者侵入性操作后大出血的发生率高于无凝血病患者（4.1%对1.6%，P = 0.023）。严重血小板减少症患者侵入性操作后大出血的发生率高于无严重血小板减少症患者（4.9%对1.6%，P = 0.008）。INR≥1.5和INR<1.5的患者侵入性操作后大出血的发生率无显著差异（4.5%对2.0%，P = 0.065）。INR≥1.5的患者住院死亡率显著高于INR<1.5的患者（6.4%对1.3%，P<0.001）。
结论
严重血小板减少症显著增加了肝硬化患者侵入性操作后大出血的风险。INR≥1.5显著增加了住院死亡率。
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