Tan Jin Lin, Lokan Thomas, Chinnaratha Mohamed Asif, Veysey Martin
Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia.
Department of Gastroenterology and Hepatology Lyell McEwin Hospital Elizabeth Vale South Australia Australia.
JGH Open. 2024 Aug 19;8(8):e70013. doi: 10.1002/jgh3.70013. eCollection 2024 Aug.
Abdominal paracentesis is a common procedure performed for both diagnostic and therapeutic purposes in patients with chronic liver disease and ascites. This review aims to provide an overview of the current evidence on the risk of bleeding associated with abdominal paracentesis. Electronic search was performed using PubMed, MEDLINE, and Ovid EMBASE from inception to 29 October 2023. Studies were included if they examined the risk of bleeding post-abdominal paracentesis or the efficacy of interventions to reduce bleeding in patients with chronic liver disease. Random-effects model was used to calculate the pooled proportions of bleeding events following abdominal paracentesis. Heterogeneity was determined by , τ statistics, and -value. Eight studies were included for review. Six studies reported incident events of post-abdominal paracentesis bleeding. Pooled proportion of bleeding events following abdominal paracentesis was 0.32% (95% CI: 0.15-0.69%). The mean values for pre-procedural INR and platelet count of patients in these studies ranged between 1.4 and 2.0, and 50 and 153 × 10/L, respectively. The highest recorded INR was 8.7, and the lowest platelet count was 19 × 10/L. Major bleeding after abdominal paracentesis occurred in 0-0.97% of the study cohorts. Two studies demonstrated that the use of thromboelastography (TEG) before paracentesis in patients with chronic liver disease identified those at risk of procedure-related bleeding and reduced transfusion requirements. The overall risk of major bleeding after abdominal paracentesis is low in patients with chronic liver disease and coagulopathy. TEG may be used to predict bleeding risk and guide transfusion requirements.
腹腔穿刺术是慢性肝病和腹水患者用于诊断和治疗目的的常见操作。本综述旨在概述目前关于腹腔穿刺术相关出血风险的证据。使用PubMed、MEDLINE和Ovid EMBASE进行电子检索，检索时间从数据库建立至2023年10月29日。如果研究检查了腹腔穿刺术后的出血风险或减少慢性肝病患者出血的干预措施的疗效，则纳入研究。采用随机效应模型计算腹腔穿刺术后出血事件的合并比例。通过 、τ统计量和 -值确定异质性。纳入八项研究进行综述。六项研究报告了腹腔穿刺术后出血的发生事件。腹腔穿刺术后出血事件的合并比例为0.32%（95%CI：0.15 - 0.69%）。这些研究中患者术前国际标准化比值（INR）和血小板计数的平均值分别在1.4至2.0以及50至153×10⁹/L之间。记录到的最高INR为8.7，最低血小板计数为19×10⁹/L。腹腔穿刺术后大出血发生在0 - 0.97%的研究队列中。两项研究表明，在慢性肝病患者穿刺术前使用血栓弹力图（TEG）可识别出有手术相关出血风险的患者，并减少输血需求。慢性肝病和凝血功能障碍患者腹腔穿刺术后大出血的总体风险较低。TEG可用于预测出血风险并指导输血需求。
