AGA Clinical Practice Guideline on the Management of Coagulation Disorders in Patients With Cirrhosis

Cirrhosis is a disease state that is accompanied by significant alterations in laboratory parameters, such as platelet count (PLT) and prothrombin time/international normalized ratio (PT/INR), routinely used to estimate clotting. Based on this measured thrombocytopenia and coagulopathy, it has traditionally been assumed that these results convey a high risk of bleeding and, therefore, significantly increased risk for patients undergoing invasive procedures. However, it has become clear that this understanding underestimates the balanced nature of alterations in hemostasis associated with end-stage liver disease, and that neither thrombocytopenia nor elevated PT/INR necessarily predicts bleeding outcomes in most of these patients.