Large volume paracentesis bleeding rare in patients with renal disease

PHILADELPHIA — The incidence of bleeding related to ultrasound-guided large volume paracentesis was rare in a cohort of high-risk patients with severe renal dysfunction and thrombocytopenia, according to results presented at the American College of Gastroenterology Annual Meeting.

“The challenge when managing these patients largely lies in the fact that we’re unable to use aggressive diuretic titration as this precipitates further kidney injury,” Lauren S. Cole, MD, from the University of Arizona College of Medicine, said during her presentation. “The efficacy of TIPS or transjugular portosystemic shunt remains debatable and studies have shown a higher incidence of severe hepatic encephalopathy in this specific population. As a result, management largely relies on the use of serial large volume paracentesis.”

According to Cole, both quantitative and qualitive platelet dysfunction in patients with cirrhosis and end-stage renal disease may increase the risk for bleeding with large volume paracentesis (LVP). Bleeding events are common in cirrhosis, she said, and patients will often have normal global coagulation related to the balance of procoagulation and anticoagulation factors.

“Our decision to pursue this study largely stemmed from the discrepancy between societal guidelines, as put forward by the American Association for the Study of Liver Diseases in 2012 as compared to the 2012 guidelines proposed by the Society of Interventional Radiology,” Cole explained.

The study comprised 757 patients, 131 of whom had platelet counts less than 50,000 and 32 of whom had counts less than 30,000. Additionally, 260 patients were on renal replacement therapy at the time of ultrasound-guided LVP.

At study end, one patient had post-LVP bleeding that required transfusion of 2 units of packed red blood cells for an incidence rate of 0.13%. No patients required angiogram intervention, were readmitted for post-procedure bleeding, or died from LVP-related complications.

“Prophylactic platelet, other blood product or desmopressin transfusion appear to be unwarranted in this population,” Cole said. “Ultimately, we feel our results promote a strong consideration toward adopting a system-wide restrictive transfusion strategy.” – by Talitha Bennett

Reference : Cole LS. Abstract 17. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Cole reports no relevant financial disclosures.