Abstract
BACKGROUND: There are limited studies assessing whether prophylactic platelet transfusions prior to high-risk procedures reduce the risk of bleeding in patients with liver cirrhosis. METHODS: We performed a post hoc analysis of two prior randomized clinical trials (CTRI/2017/12/010822 and CTRI/2021/05/033464), which compared thromboelastography-guided prophylactic platelet transfusion to standard-of-care (empirical prophylactic transfusion for all patients prior to the procedure) or on-demand transfusion (no prophylactic transfusions). We aimed to assess the risk of major procedure-related bleeding or mortality among patients who had received prophylactic platelet transfusions versus those who did not (on-demand transfusions). RESULTS: A total of 118 patients were included in the analysis, with baseline demographics well matched between groups. The leading etiologies of cirrhosis were cryptogenic (42, 35.6%) and autoimmune liver disease (30, 25.4%). The most common procedures performed were percutaneous liver biopsy (73, 61.8%), followed by transjugular intrahepatic portosystemic shunt (14, 11.9%) and transarterial chemoembolization (14, 11.9%). No episode of major bleeding or procedure-related mortality occurred in either group, though minor bleeding occurred in 5 patients. A significantly lower number of patients in the on-demand group required platelet transfusions than those receiving empirical transfusions as part of standard care. CONCLUSION: Procedure-related bleeding rates were not significantly higher among patients with liver cirrhosis undergoing high-risk procedures without prophylactic platelet transfusions than in those who received them. Larger randomized trials are required to validate these findings from our post hoc analysis.