A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation

Background & Aims Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL). Methods This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1.5 and/or platelet count
Graphical abstract
Highlights • Multicenter analysis of prophylactic administration of blood products in 536 outpatients with cirrhosis undergoing EBL. • The prophylactic transfusion protocol was only followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. • Post EBL-bleeding occurred in 26 patients – 4.8% of patients and in 2.2% of procedures. • Patients that bled had higher Child-Pugh and MELD scores compared to those that did not bleed. • There was no clear relationship between post-EBL bleeding and the baseline INR/platelet count before the procedure.