Measuring coagulation parameters in patients with cirrhosis prior to procedures with low or moderate bleeding risk

Virginia Hernández-Gea, MD, PhD, is a hepatologist and researcher at the Hospital Clínic de Barcelona, Spain. Her main research interests are portal hypertension and vascular diseases. She contributed to guidelines on esophageal varices from the American Association for the Study of Liver Diseases.

What tests should be performed in an individual with advanced liver disease (cirrhosis) prior to a scheduled low or moderate bleeding risk procedure, and how to prepare the patient for the procedure?

Virginia Hernández-Gea, MD, PhD: There is this misconception that patients with chronic liver disease have an alteration in coagulation parameters and that this alteration means bleeding risk. We know from research in the last year that the alterations in the coagulation parameters do reflect poor liver function and they get altered when the patient’s got liver disease, meaning that these parameters will not help us predict the risk of bleeding after procedures. This is why the most recent guidelines from the European Society of Liver Diseases do not recommend checking coagulation parameters before doing invasive procedures in patients with advanced liver disease.