Management of haemostatic alterations and associated disorders in cirrhosis in Spain: A national survey.
Adult
Anticoagulants
/ therapeutic use
Blood Coagulation Disorders
/ drug therapy
Female
Gastroenterology
/ methods
Health Knowledge, Attitudes, Practice
Hemostasis
/ physiology
Humans
International Normalized Ratio
Liver Cirrhosis
/ complications
Male
Middle Aged
Practice Guidelines as Topic
Practice Patterns, Physicians'
/ statistics & numerical data
Risk Factors
Spain
Surveys and Questionnaires
Anticoagulants
Haemorrhage
Haemostasis
Thrombosis
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
17
03
2018
revised:
17
05
2018
accepted:
01
06
2018
pubmed:
2
7
2018
medline:
14
6
2019
entrez:
2
7
2018
Statut:
ppublish
Résumé
Knowledge of haematological abnormalities in cirrhosis has greatly improved in recent years. To evaluate how Spanish Digestive Disease specialists manage haemostatic alterations and associated disorders in patients with cirrhosis. All members of the Spanish Association for the Study of the Liver and Spanish Society of Digestive Pathology were invited to fill in a web-based questionnaire. 135 professionals, 93 hepatologists and 42 non-hepatologists responded to the survey. The concept of rebalanced haemostasis was known by 74.8% of them. Most specialists corrected the INR and thrombocytopenia before invasive procedures with moderate risk of bleeding or major surgery and in severe gastrointestinal bleeding. The threshold of platelets and, especially, INR used to administer blood products varied greatly. Pharmacological prophylaxis of venous thromboembolism prevailed, but it was highly dependent on the INR and platelet figures. Most participants initiated anticoagulation regardless of the degree of portal vein thrombosis, even in patients ineligible for transplantation. In potential candidates, only 56% maintained it indefinitely or until liver transplantation. No major differences between hepatologists and non-hepatologists were found. A significant variability and certain deviation from current guidelines was observed among Spanish Digestive Disease specialists regarding management of haemostatic alterations and associated disorders in cirrhosis.
Sections du résumé
BACKGROUND
Knowledge of haematological abnormalities in cirrhosis has greatly improved in recent years.
AIMS
To evaluate how Spanish Digestive Disease specialists manage haemostatic alterations and associated disorders in patients with cirrhosis.
METHODS
All members of the Spanish Association for the Study of the Liver and Spanish Society of Digestive Pathology were invited to fill in a web-based questionnaire.
RESULTS
135 professionals, 93 hepatologists and 42 non-hepatologists responded to the survey. The concept of rebalanced haemostasis was known by 74.8% of them. Most specialists corrected the INR and thrombocytopenia before invasive procedures with moderate risk of bleeding or major surgery and in severe gastrointestinal bleeding. The threshold of platelets and, especially, INR used to administer blood products varied greatly. Pharmacological prophylaxis of venous thromboembolism prevailed, but it was highly dependent on the INR and platelet figures. Most participants initiated anticoagulation regardless of the degree of portal vein thrombosis, even in patients ineligible for transplantation. In potential candidates, only 56% maintained it indefinitely or until liver transplantation. No major differences between hepatologists and non-hepatologists were found.
CONCLUSIONS
A significant variability and certain deviation from current guidelines was observed among Spanish Digestive Disease specialists regarding management of haemostatic alterations and associated disorders in cirrhosis.
Identifiants
pubmed: 29960901
pii: S1590-8658(18)30770-9
doi: 10.1016/j.dld.2018.06.003
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
95-103Informations de copyright
Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.