Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy.
Ann Hepatol. 2018 Jun 5;17(5):830-835. doi: 10.5604/01.3001.0012.0775.
EVBL is a procedure frequently performed in cirrhotic patients for primary prophylaxis of bleeding. Patients with cirrhosis display various degrees of alteration of common coagulation parameters, and it is not known whether these alterations may predict post-EVBL bleeding. To evaluate factors predictive of post-endoscopic variceal band ligation (EVBL) bleeding in cirrhotic patients with thrombocytopenia.
We included 109 patients with cirrhosis undergoing EVBL for primary prophylaxis of variceal bleeding. Common coagulation parameters (INR, fibrinogen levels) and complete haemogram were obtained in all patients and evaluated subdividing patients in bleeders and non bleeders following EVBL.
The incidence of post-EVBL bleeding was 5.5% (6 patients). INR and platelet counts, considered as continuous or dichotomous variables according to common cut-offs (i.e., INR>1.5, platelet count <50x109/L) were not predictors of post-EVBL bleeding. Patients who bled had significantly lower fibrinogen levels [146 mg/dL (98 - 262) versus 230 mg/dL (104 - 638), P=0.009], and no other biochemical or clinical predictors of bleeding were identified. A fibrinogen cut-off of 179 mg/dL had 98.6% negative predictive value for bleeding.
low fibrinogen levels are associated with an increased risk of bleeding following prophylactic EVBL in cirrhotic patients, and might be used to stratify patients' risk. However, due to their preliminary nature, these findings need to be confirmed in larger populations.
EVBL 是肝硬化患者中经常进行的一种程序，用于原发性出血预防。肝硬化患者表现出各种程度的常见凝血参数改变，目前尚不清楚这些改变是否可预测 EVBL 后的出血。本研究旨在评估血小板减少症的肝硬化患者行 EVBL 后发生出血的预测因素。
我们纳入了 109 例行 EVBL 以预防静脉曲张出血的肝硬化患者。所有患者均获得了常见凝血参数（INR、纤维蛋白原水平）和全血细胞计数，并根据 EVBL 后是否发生出血将患者分为出血组和非出血组进行评估。
EVBL 后出血的发生率为 5.5%（6 例）。INR 和血小板计数，根据常见的截断值（即 INR>1.5、血小板计数 <50x109/L）被视为连续或离散变量，均不是 EVBL 后出血的预测因素。出血患者的纤维蛋白原水平明显较低[146mg/dL（98-262）比 230mg/dL（104-638），P=0.009]，且未发现其他出血的生化或临床预测因素。纤维蛋白原截断值为 179mg/dL 时对出血的阴性预测值为 98.6%。
在肝硬化患者中，预防性 EVBL 后纤维蛋白原水平较低与出血风险增加相关，可能用于分层患者的风险。然而，由于这些发现是初步的，因此需要在更大的人群中进行验证。
