Unità di Medicina II, Azienda Socio Sanitaria Territoriale (ASST) Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
Unità di Chirurgia Epatobilliare, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
Hepatol Commun. 2022 Feb;6(2):423-434. doi: 10.1002/hep4.1806. Epub 2021 Oct 30.
In patients with cirrhosis with severe thrombocytopenia (platelet count [PC] <50 × 10 /L) and undergoing invasive procedures, it is common clinical practice to increase the PC with platelet transfusions or thrombopoietin receptor agonists to reduce the risk of major periprocedural bleeding. The aim of our study was to investigate the association between native PC and perioperative bleeding in patients with cirrhosis undergoing surgical procedures for the treatment of hepatocellular carcinoma (HCC). We retrospectively evaluated 996 patients with cirrhosis between 1996 and 2018 who underwent surgical treatments of HCC by liver resection (LR) or radiofrequency ablation (RFA) without prophylactic platelet transfusions. Patients were allocated to the following three groups based on PC: high (>100 × 10 /L), intermediate (51-100 × 10 /L), and low (≤50 × 10 /L). PC was also analyzed as a continuous covariate on multivariable analysis. The primary endpoint was major perioperative bleeding. The overall event rate of major perioperative bleeding was 8.9% and was not found to differ significantly between the high, intermediate, and low platelet groups (8.1% vs. 10.2% vs. 10.8%, P = 0.48). On multivariable analysis, greater age, aspartate aminotransferase, lower hemoglobin, and treatment with LR (vs. RFA) were found to be significant independent predictors of major perioperative bleeding, with associations with disease etiology and year of surgery also observed. After adjusting for these factors, the association between PC and major perioperative bleeding remained nonsignificant. Conclusion: Major perioperative bleeding was not significantly associated with PC in patients with cirrhosis undergoing surgical treatment of HCC, even when their PC was <50 × 10 /L. With the limit of a retrospective analysis, our data do not support the recommendation of increasing PC in patients with severe thrombocytopenia in order to decrease their perioperative bleeding risk.
在患有肝硬化且血小板严重减少（血小板计数 [PC] <50×10/L）并接受有创操作的患者中，常见的临床实践是通过血小板输注或血小板生成素受体激动剂增加 PC，以降低主要围手术期出血的风险。我们的研究目的是探讨原发性 PC 与接受手术治疗肝细胞癌（HCC）的肝硬化患者围手术期出血之间的关系。我们回顾性评估了 1996 年至 2018 年间接受肝切除术（LR）或射频消融术（RFA）治疗 HCC 且未预防性血小板输注的 996 例肝硬化患者。根据 PC 将患者分为以下三组：高（>100×10/L）、中（51-100×10/L）和低（≤50×10/L）。在多变量分析中还分析了 PC 作为连续协变量。主要终点是主要围手术期出血。主要围手术期出血的总事件率为 8.9%，高、中、低血小板组之间无显著差异（8.1%比 10.2%比 10.8%，P=0.48）。多变量分析发现，年龄较大、天冬氨酸转氨酶升高、血红蛋白较低以及接受 LR（与 RFA 相比）治疗是主要围手术期出血的显著独立预测因素，还观察到与疾病病因和手术年份的关联。在调整这些因素后，PC 与主要围手术期出血之间的关联仍然不显著。结论：在接受 HCC 手术治疗的肝硬化患者中，主要围手术期出血与 PC 无显著相关性，即使其 PC <50×10/L。由于这是一项回顾性分析，我们的数据不支持为降低围手术期出血风险而建议增加严重血小板减少症患者的 PC。
