Influência dos parâmetros da coagulação no sangramento após ligadura elástica de varizes esofagianas em pacientes cirróticos / Influence of coagulation parameters in the blood after band ligation of esophageal varices in cirrhotic patients

AUTOR(ES)

Evandra Cristina Vieira da Rocha

DATA DE PUBLICAÇÃO

2011

RESUMO

BACKGROUND &AIMS. There is controversy over whether coagulation status predicts bleeding caused by ulceration after esophageal varices band ligation (EVL). METHODS: EVL was performed for primary (n=45) or secondary (n=105) prophylaxis in 150 patients with cirrhosis (Child A, n=74 [49%]; Child B, n=42 [28%]; Child C, n=34 [23%]). International Normalized Ratio (INR) and platelet counts (PC) were assessed in all. In 92 patients, levels of factor V, fibrinogen, D-dimer, protein C and protein S, von Willebrand factor and thromboelastography (TEG) were assessed. PC <50x103/mm3 and INR >1.5 were considered high-risk cutoffs for bleeding. Conversely, PC 50x103/mm3 with INR 1.5 were safe cutoffs. RESULTS: Overall, 11 patients (7.3%) had post-EVL ulcer bleeding. Bleeding occurred in 5 patients with Child A/B (4.3%) and 6 patients with Child C (17%) (p=0.0174 for Child A/B versus Child C). Eight patients with bleeding were among the 110 below the cutoff for INR and PC, whereas only 3 of the patients with bleeding were among the 40 patients with purported high-risk values (p=1.0). Among the 92 patients with expanded coagulation tests, bleeding occurred in 5. There was no difference in any of the coagulation parameters, including overall TEG patterns, between patients who did and did not bleed. CONCLUSION: Post-EVL ulcer bleeding was associated with Child C status but not with conventional or expanded coagulation indices in cirrhotic patients without renal failure or infection undergoing elective EVL. These results call into question the common use of prophylactic procoagulants in the elective setting. common use of prophylactic procoagulants in the elective setting

ASSUNTO(S)

blood coagulation tests cirrhosis cirrose esophageal and gastric varices hemorragia gastrointestinal ligadura ligation testes de coagulação sanguínea varizes esofágicas e gástricas

Documentos Relacionados

• Microwave coagulation versus sclerotherapy after band ligation for treatment of esophageal varices in cirrhotic
• Bacteremia em pacientes cirróticos submetidos a ligadura elástica endoscópica de varizes esofágicas
• Estudo da motilidade esofágica após ligadura elástica endoscópica das varizes
• Comparação da esclerose endoscópica com a ligadura elástica para o tratamento da fase aguda da hemorragia por ruptura de varizes de esôfago
• Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis