{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:35:36Z","timestamp":1787654136546,"version":"build-2736575974"},"reference-count":103,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006595","name":"UEFISCDI","doi-asserted-by":"publisher","award":["PCE 80\/2022\/PN-III-P4-PCE-2021-0601 \u201dTEG-HANDLED\u201d"],"award-info":[{"award-number":["PCE 80\/2022\/PN-III-P4-PCE-2021-0601 \u201dTEG-HANDLED\u201d"]}],"id":[{"id":"10.13039\/501100006595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of procedures like paracentesis, endoscopic therapy, and various interventional procedures. As such, this paper aims to provide a comprehensive analysis of current data, guidelines, and practices for managing coagulation in cirrhotic patients, with a focus on minimizing bleeding risk while avoiding unnecessary correction with blood products. The objectives of this review are threefold: first, to outline the existing evidence on bleeding risks associated with common invasive procedures in cirrhotic patients; second, to evaluate the efficacy and limitations of standard and advanced coagulation tests in predicting procedural bleeding; and third, to examine the role of blood product transfusions and other hemostatic interventions, considering potential risks and benefits in this delicate population. In doing so, this review highlights patient-specific and procedure-specific factors that influence bleeding risk and informs best practices to optimize patient outcomes. This review progresses through key procedures often performed in cirrhotic patients. The discussion begins with paracentesis, a low-risk procedure, followed by endoscopic therapy for varices, and concludes with high-risk interventions requiring advanced hemostatic considerations. Each chapter addresses procedural techniques, bleeding risk assessment, and evidence-based correction approaches. This comprehensive structure aims to guide clinicians in making informed, evidence-backed decisions in managing coagulation in cirrhosis, ultimately reducing procedural complications and improving care quality for this high-risk population.<\/jats:p>","DOI":"10.3390\/diagnostics14222602","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T07:02:58Z","timestamp":1732086178000},"page":"2602","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Bleeding Edge: Managing Coagulation and Bleeding Risk in Patients with Cirrhosis Undergoing Interventional Procedures"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-8630","authenticated-orcid":false,"given":"Rare\u0219","family":"Cr\u0103ciun","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Gastoenterology Clinic, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Grap\u0103","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Gastoenterology Clinic, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tudor","family":"Mocan","sequence":"additional","affiliation":[{"name":"Gastoenterology Clinic, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"},{"name":"UBBmed Department, Babe\u0219-Bolyai University, 400084 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Tefas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Gastoenterology Clinic, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iuliana","family":"Nenu","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Buliarc\u0103","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4034-5471","authenticated-orcid":false,"given":"Horia","family":"\u0218tef\u0103nescu","sequence":"additional","affiliation":[{"name":"Gastoenterology Clinic, \u201cProf. Dr. O. 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Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeno","family":"Sp\u00e2rchez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"Gastoenterology Clinic, \u201cProf. Dr. O. Fodor\u201d Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1111\/jth.15239","article-title":"The Concept of Rebalanced Hemostasis in Patients with Liver Disease: Communication from the ISTH SSC Working Group on Hemostatic Management of Patients with Liver Disease","volume":"19","author":"Lisman","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4948","DOI":"10.1182\/blood-2019-132251","article-title":"Low Sensitivity to Thrombomodulin Correlates with Liver Stiffness in Advanced Chronic Liver Disease","volume":"134","author":"Brodard","year":"2019","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.thromres.2021.09.007","article-title":"Resistance to Thrombomodulin Correlates with Liver Stiffness in Chronic Liver Disease a Prospective Single-Center Cohort Study","volume":"207","author":"Brodard","year":"2021","journal-title":"Thromb. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/hep.21231","article-title":"Elevated Levels of von Willebrand Factor in Cirrhosis Support Platelet Adhesion despite Reduced Functional Capacity","volume":"44","author":"Lisman","year":"2006","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1160\/TH08-01-0006","article-title":"Comprehensive Analysis of ADAMTS13 in Patients with Liver Cirrhosis","volume":"99","author":"Masahito","year":"2008","journal-title":"Thromb. Haemost."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","article-title":"Baveno VII\u2014Renewing Consensus in Portal Hypertension","volume":"76","author":"Bosch","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lu, Z., Sun, X., Han, J., Jin, B., Zhang, W., Han, J., Ma, X., Liu, B., Yu, X., and Wu, Q. (2020). Characteristics of Peptic Ulcer Bleeding in Cirrhotic Patients with Esophageal and Gastric Varices. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-76530-3"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1016\/j.jhep.2021.01.025","article-title":"Sarcopenia and Frailty in Decompensated Cirrhosis","volume":"75","author":"Tandon","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3290","DOI":"10.3748\/wjg.v27.i23.3290","article-title":"Viscoelastic Tests in Liver Disease: Where Do We Stand Now?","volume":"27","author":"Buliarca","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s12072-020-10036-y","article-title":"Viscoelastic Test-Based Bleeding Risk Score Reliably Predicts Coagulopathic Bleeding in Decompensated Cirrhosis and ACLF Patients","volume":"14","author":"Bihari","year":"2020","journal-title":"Hepatol. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1053\/j.gastro.2019.03.070","article-title":"AGA Clinical Practice Update: Coagulation in Cirrhosis","volume":"157","author":"Greenberg","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.jhep.2021.09.003","article-title":"EASL Clinical Practice Guidelines on Prevention and Management of Bleeding and Thrombosis in Patients with Cirrhosis","volume":"76","author":"Villa","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1002\/hep.28628","article-title":"Coagulation Parameters and Major Bleeding in Critically Ill Patients with Cirrhosis","volume":"64","author":"Drolz","year":"2016","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1046\/j.1537-2995.1991.31291142949.x","article-title":"Lack of Increased Bleeding after Paracentesis and Thoracentesis in Patients with Mild Coagulation Abnormalities","volume":"31","author":"McVay","year":"1991","journal-title":"Transfusion"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1111\/liv.13712","article-title":"Acute Kidney Injury, but Not Sepsis, Is Associated with Higher Procedure-Related Bleeding in Patients with Decompensated Cirrhosis","volume":"38","author":"Hung","year":"2018","journal-title":"Liver Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1055\/a-1515-9529","article-title":"Intraperitoneal Activation of Coagulation and Fibrinolysis in Patients with Cirrhosis and Ascites","volume":"122","author":"Thaler","year":"2022","journal-title":"Thromb. Haemost."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1002\/hep.20317","article-title":"Performance Standards for Therapeutic Abdominal Paracentesis","volume":"40","author":"Grabau","year":"2004","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e2225","DOI":"10.1097\/MD.0000000000002225","article-title":"Hemorrhagic Complications Following Abdominal Paracentesis in Acute on Chronic Liver Failure","volume":"94","author":"Lin","year":"2015","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.cgh.2010.03.025","article-title":"Complication Rate of Percutaneous Liver Biopsies Among Persons With Advanced Chronic Liver Disease in the HALT-C Trial","volume":"8","author":"Seeff","year":"2010","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1007\/BF01307514","article-title":"Incidence of Ultrasound-Detected Intrahepatic Hematomas Due to Tru-Cut Needle Liver Biopsy","volume":"36","author":"Sugano","year":"1991","journal-title":"Dig. Dis. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/0016-5085(87)90119-3","article-title":"Prospective Study of the Incidence of Ultrasound-Detected Intrahepatic and Subcapsular Hematomas in Patients Randomized to 6 or 24 Hours of Bed Rest after Percutaneous Liver Biopsy","volume":"92","author":"Minuk","year":"1987","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1053\/j.gastro.2021.09.004","article-title":"AGA Technical Review on Coagulation in Cirrhosis","volume":"161","author":"Intagliata","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1111\/jth.15903","article-title":"Bleeding after Liver Biopsy: Remarkably Infrequent but Potentially Serious and Unfortunately Unpredictable by Extensive Clinical Laboratory Analyses\u2014Take a Closer Look at the Biopsy?","volume":"20","author":"Caldwell","year":"2022","journal-title":"J. Thromb. Haemost."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11894-017-0585-6","article-title":"Bleeding Risk with Invasive Procedures in Patients with Cirrhosis and Coagulopathy","volume":"19","author":"Zakeri","year":"2017","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1007\/s00261-017-1319-9","article-title":"Percutaneous Liver Biopsy and Revised Coagulation Guidelines: A 9-Year Experience","volume":"43","author":"Kitchin","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1111\/bjh.15574","article-title":"Avatrombopag, an Oral Thrombopoietin Receptor Agonist: Results of Two Double-blind, Dose-rising, Placebo-controlled Phase 1 Studies","volume":"183","author":"Kuter","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1002\/hep.30561","article-title":"Lusutrombopag for the Treatment of Thrombocytopenia in Patients With Chronic Liver Disease Undergoing Invasive Procedures (L-PLUS 2)","volume":"70","author":"Simon","year":"2019","journal-title":"Hepatology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1136\/gutjnl-2020-321299","article-title":"Guidelines on the Use of Liver Biopsy in Clinical Practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology","volume":"69","author":"Neuberger","year":"2020","journal-title":"Gut"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1002\/hep.22742","article-title":"Liver Biopsy","volume":"49","author":"Rockey","year":"2009","journal-title":"Hepatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/j.jvir.2019.04.017","article-title":"Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions\u2014Part II: Recommendations","volume":"30","author":"Patel","year":"2019","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1055\/s-0035-1566760","article-title":"EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II","volume":"36","author":"Sidhu","year":"2015","journal-title":"Ultraschall Der Med. -Eur. J. Ultrasound"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"692.e9","DOI":"10.1016\/j.crad.2017.03.001","article-title":"Early Complications after Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma: An Analysis of 1,843 Ablations in 1,211 Patients in a Single Centre: Experience over 10 Years","volume":"72","author":"Park","year":"2017","journal-title":"Clin. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jhep.2004.11.042","article-title":"Treatment of Hepatocellular Carcinoma in Compensated Cirrhosis with Radio-Frequency Thermal Ablation (RFTA): A Prospective Study","volume":"42","author":"CAMMA","year":"2005","journal-title":"J. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1097\/MCG.0b013e3181b7ed76","article-title":"Hemorrhagic Complications of Percutaneous Radiofrequency Ablation for Liver Tumors","volume":"44","author":"Goto","year":"2010","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s00270-020-02471-z","article-title":"CIRSE Standards of Practice on Thermal Ablation of Liver Tumours","volume":"43","author":"Crocetti","year":"2020","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2104","DOI":"10.1007\/s10620-019-05939-2","article-title":"A Randomized Control Trial of Thromboelastography-Guided Transfusion in Cirrhosis for High-Risk Invasive Liver-Related Procedures","volume":"65","author":"Vuyyuru","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2590","DOI":"10.1016\/j.transproceed.2010.05.144","article-title":"Thromboelastography-Guided Transfusion Decreases Intraoperative Blood Transfusion During Orthotopic Liver Transplantation: Randomized Clinical Trial","volume":"42","author":"Wang","year":"2010","journal-title":"Transplant. Proc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"EASL Clinical Practice Guidelines for the Management of Patients with Decompensated Cirrhosis","volume":"69","author":"Angeli","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jhep.2007.10.008","article-title":"Hepatic Venous Pressure Gradient and Prognosis in Patients with Acute Variceal Bleeding Treated with Pharmacologic and Endoscopic Therapy","volume":"48","author":"Abraldes","year":"2008","journal-title":"J. Hepatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1038\/nrgastro.2009.149","article-title":"The Clinical Use of HVPG Measurements in Chronic Liver Disease","volume":"6","author":"Bosch","year":"2009","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1053\/j.gastro.2006.09.013","article-title":"Hepatic Vein Pressure Gradient Reduction and Prevention of Variceal Bleeding in Cirrhosis: A Systematic Review","volume":"131","author":"Luca","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis and Management: 2016 practice guidance by the American Association for the study of liver diseases","volume":"65","author":"Abraldes","year":"2017","journal-title":"Hepatology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e00288","DOI":"10.14309\/ctg.0000000000000288","article-title":"Bleeding After Elective Interventional Endoscopic Procedures in a Large Cohort of Patients with Cirrhosis","volume":"11","author":"Kundumadam","year":"2020","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.cgh.2009.04.019","article-title":"A Prospective Study of Conventional and Expanded Coagulation Indices in Predicting Ulcer Bleeding After Variceal Band Ligation","volume":"7","author":"Caldwell","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1111\/apt.16078","article-title":"Systematic Review with Meta-Analysis: Abnormalities in the International Normalised Ratio Do Not Correlate with Periprocedural Bleeding Events among Patients with Cirrhosis","volume":"52","author":"Kovalic","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1365-2036.2010.04331.x","article-title":"Predictive Factors of Bleeding Related to Post-Banding Ulcer Following Endoscopic Variceal Ligation in Cirrhotic Patients: A Case-Control Study","volume":"32","author":"Vanbiervliet","year":"2010","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"830","DOI":"10.5604\/01.3001.0012.0775","article-title":"Low Fibrinogen Levels Are Associated with Bleeding after Varices Ligation in Thrombocytopenic Cirrhotic Patients","volume":"17","author":"Giannini","year":"2018","journal-title":"Ann. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/liv.12211","article-title":"Prophylactic Anticoagulation for Venous Thromboembolism in Hospitalized Cirrhosis Patients Is Not Associated with High Rates of Gastrointestinal Bleeding","volume":"34","author":"Intagliata","year":"2014","journal-title":"Liver Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1002\/hep.27783","article-title":"Impact of Anticoagulation on Upper-Gastrointestinal Bleeding in Cirrhosis. A Retrospective Multicenter Study","volume":"62","author":"Cerini","year":"2015","journal-title":"Hepatology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1111\/jth.15364","article-title":"Treatment of Bleeding in Patients with Liver Disease","volume":"19","author":"Northup","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1002\/hep.31646","article-title":"Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients with Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"73","author":"Northup","year":"2021","journal-title":"Hepatology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1111\/liv.14988","article-title":"Fresh Frozen Plasma in Treating Acute Variceal Bleeding: Not Effective and Likely Harmful","volume":"41","author":"Lisman","year":"2021","journal-title":"Liver Int."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1055\/a-1939-4887","article-title":"Endoscopic Diagnosis and Management of Esophagogastric Variceal Hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Gralnek","year":"2022","journal-title":"Endoscopy"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1111\/liv.14936","article-title":"Fresh Frozen Plasma Transfusion in Acute Variceal Haemorrhage: Results from a Multicentre Cohort Study","volume":"41","author":"Mohanty","year":"2021","journal-title":"Liver Int."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Fu, X., Yan, D., Huang, W., Xie, X., Zhou, Y., Li, H., Wang, Y., Pei, S., Yao, R., and Li, N. (2024). Efficacy of Fresh Frozen Plasma Transfusion in Decompensated Cirrhosis Patients with Coagulopathy Admitted to ICU: A Retrospective Cohort Study from MIMIC-IV Database. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-54379-0"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.4254\/wjh.v14.i7.1421","article-title":"Effect of Thrombocytopenia and Platelet Transfusion on Outcomes of Acute Variceal Bleeding in Patients with Chronic Liver Disease","volume":"14","author":"Biswas","year":"2022","journal-title":"World J. Hepatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"100363","DOI":"10.1016\/j.jhepr.2021.100363","article-title":"A Multicenter Analysis of the Role of Prophylactic Transfusion of Blood Products in Patients with Cirrhosis and Esophageal Varices Undergoing Endoscopic Band Ligation","volume":"3","author":"Blasi","year":"2021","journal-title":"JHEP Rep."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0002-9610(01)00589-X","article-title":"Complications of Endoscopy","volume":"181","author":"Kavic","year":"2001","journal-title":"Am. J. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"190","DOI":"10.3748\/wjg.v25.i2.190","article-title":"Adverse Events Related to Colonoscopy: Global Trends and Future Challenges","volume":"25","author":"Kim","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1067\/mge.2000.105773","article-title":"Postpolypectomy Lower GI Bleeding: Descriptive Analysis","volume":"51","author":"Sorbi","year":"2000","journal-title":"Gastrointest. Endosc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.gie.2011.07.025","article-title":"Complications of Colonoscopy","volume":"74","author":"Fisher","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1055\/s-2005-870512","article-title":"The Munich Polypectomy Study (MUPS): Prospective Analysis of Complications and Risk Factors in 4000 Colonic Snare Polypectomies","volume":"37","author":"Heldwein","year":"2005","journal-title":"Endoscopy"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1007\/BF02052261","article-title":"Hemorrhage Following Colonoscopic Polypectomy","volume":"36","author":"Rosen","year":"1993","journal-title":"Dis. Colon Rectum"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"755","DOI":"10.5009\/gnl19131","article-title":"Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy","volume":"14","author":"Soh","year":"2020","journal-title":"Gut Liver"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"E947","DOI":"10.1055\/s-0042-111317","article-title":"Colonoscopy with Polypectomy Is Associated with a Low Rate of Complications in Patients with Cirrhosis","volume":"04","author":"Huang","year":"2016","journal-title":"Endosc. Int. Open"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"618","DOI":"10.3109\/00365521.2015.1121513","article-title":"Incidence and Risk Factors of Delayed Postpolypectomy Bleeding in Patients with Chronic Liver Disease","volume":"51","author":"Lee","year":"2016","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.3349\/ymj.2014.55.5.1281","article-title":"Child-Pugh Score Is an Independent Risk Factor for Immediate Bleeding after Colonoscopic Polypectomy in Liver Cirrhosis","volume":"55","author":"Lee","year":"2014","journal-title":"Yonsei Med. J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"4813","DOI":"10.1007\/s10620-021-07364-w","article-title":"Advanced Endoscopic Resection Techniques in Cirrhosis\u2014A Systematic Review and Meta-Analysis of Outcomes","volume":"67","author":"Chandan","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/MCG.0000000000001407","article-title":"Risk Factors Associated with Postendoscopic Mucosal Resection Bleeding in Patients with Cirrhosis: A Retrospective Multicenter Cohort Study","volume":"55","author":"Hasan","year":"2021","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.cld.2021.09.001","article-title":"Polypectomy, Endoscopic Mucosal Resection, and Endoscopic Submucosal Dissection in the Cirrhotic Population","volume":"26","author":"Nakshabandi","year":"2022","journal-title":"Clin. Liver Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1111\/j.1572-0241.2007.01279.x","article-title":"Incidence Rates of Post-ERCP Complications: A Systematic Survey of Prospective Studies","volume":"102","author":"Andriulli","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1038\/s41395-018-0218-1","article-title":"Adverse Events and Acute Chronic Liver Failure in Patients with Cirrhosis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Multicenter Matched-Cohort Study","volume":"114","author":"Leal","year":"2019","journal-title":"Am. J. Gastroenterol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"354","DOI":"10.4253\/wjge.v10.i11.354","article-title":"Endoscopic Retrograde Cholangiopancreatography in Cirrhosis\u2014A Systematic Review and Meta-Analysis Focused on Adverse Events","volume":"10","author":"Mashiana","year":"2018","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-Related Adverse Events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s43066-024-00311-0","article-title":"Safety, Risk Stratification, and Cost of ERCP in Patients with Cirrhosis: A Prospective Controlled Study","volume":"14","author":"Attia","year":"2024","journal-title":"Egypt. Liver J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"E303","DOI":"10.1055\/s-0043-102492","article-title":"Safety of ERCP in Patients with Liver Cirrhosis: A National Database Study","volume":"05","author":"Navaneethan","year":"2017","journal-title":"Endosc. Int. Open"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"440","DOI":"10.3349\/ymj.2019.60.5.440","article-title":"Bleeding Complications and Clinical Safety of Endoscopic Retrograde Cholangiopancreatography in Patients with Liver Cirrhosis","volume":"60","author":"Kim","year":"2019","journal-title":"Yonsei Med. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e433","DOI":"10.1097\/MD.0000000000000433","article-title":"MELD Scores and Child-Pugh Classifications Predict the Outcomes of ERCP in Cirrhotic Patients with Choledocholithiasis: A Retrospective Cohort Study","volume":"94","author":"Zhang","year":"2015","journal-title":"Medicine"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.amjcard.2012.05.043","article-title":"Usefulness of International Normalized Ratio to Predict Bleeding Complications in Patients with End-Stage Liver Disease Who Undergo Cardiac Catheterization","volume":"110","author":"Townsend","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"177","DOI":"10.14740\/gr873w","article-title":"International Normalized Ratio Does Not Predict Gastrointestinal Bleeding After Endoscopic Retrograde Cholangiopancreatography in Patients with Cirrhosis","volume":"10","author":"Adike","year":"2017","journal-title":"Gastroenterol. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.gie.2015.08.022","article-title":"Efficacy and Safety of Therapeutic ERCP in Patients with Cirrhosis: A Large Multicenter Study","volume":"83","author":"Adler","year":"2016","journal-title":"Gastrointest. Endosc."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"E22051","DOI":"10.1097\/MD.0000000000022051","article-title":"Efficacy and Safety of ERCP in Patients with Gastroesophageal Varices","volume":"99","author":"Hong","year":"2020","journal-title":"Medicine"},{"key":"ref_83","first-page":"896","article-title":"The Risk of Variceal Bleeding during Endoscopic Retrograde Cholangiopancreatography","volume":"85","author":"Lu","year":"2022","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1053\/gast.2001.25481","article-title":"Thrombin-Activatable Fibrinolysis Inhibitor Deficiency in Cirrhosis Is Not Associated With Increased Plasma Fibrinolysis","volume":"121","author":"Lisman","year":"2001","journal-title":"Gastroenterology"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1002\/hep.20569","article-title":"Evidence of Normal Thrombin Generation in Cirrhosis despite Abnormal Conventional Coagulation Tests","volume":"41","author":"Tripodi","year":"2005","journal-title":"Hepatology"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1111\/j.1538-7836.2011.04429.x","article-title":"Hypercoagulability in Cirrhosis: Causes and Consequences","volume":"9","author":"Tripodi","year":"2011","journal-title":"J. Thromb. Haemost."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1016\/j.cgh.2023.04.016","article-title":"Bleeding and Thrombotic Complications in Patients With Cirrhosis: A State-of-the-Art Appraisal","volume":"21","author":"Rautou","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/jth.15562","article-title":"Periprocedural Management of Abnormal Coagulation Parameters and Thrombocytopenia in Patients with Cirrhosis: Guidance from the SSC of the ISTH","volume":"20","author":"Roberts","year":"2022","journal-title":"J. Thromb. Haemost."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1002\/hep.31443","article-title":"Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo-coagulable and Hyper-coagulable Features","volume":"72","author":"Zanetto","year":"2020","journal-title":"Hepatology"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.jhep.2023.01.010","article-title":"Haemostasis in Cirrhosis: Understanding Destabilising Factors during Acute Decompensation","volume":"78","author":"Zanetto","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.jhep.2021.11.004","article-title":"Haemostatic Alterations and Management of Haemostasis in Patients with Cirrhosis","volume":"76","author":"Lisman","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s11239-023-02941-4","article-title":"Treating Periprocedural Bleeding in Patients with Cirrhosis","volume":"57","author":"Sabate","year":"2024","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e886","DOI":"10.1097\/HS9.0000000000000886","article-title":"Bleeding and Thrombosis in Patients With Cirrhosis: What\u2019s New?","volume":"7","author":"Lisman","year":"2023","journal-title":"Hemasphere"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.4254\/wjh.v7.i14.1818","article-title":"Spontaneous Bleeding or Thrombosis in Cirrhosis: What Should Be Feared the Most?","volume":"7","year":"2015","journal-title":"World J. Hepatol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/cld.976","article-title":"Current Concepts in Coagulation Profile in Cirrhosis and Acute-on-Chronic Liver Failure","volume":"16","author":"Premkumar","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/ijlh.12539","article-title":"Current and Emerging Approaches for Evaluating Platelet Disorders","volume":"38","author":"Podda","year":"2016","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jcrc.2017.07.053","article-title":"Balanced Haemostasis with Both Hypo- and Hyper-Coagulable Features in Critically Ill Patients with Acute-on-Chronic-Liver Failure","volume":"43","author":"Fisher","year":"2018","journal-title":"J. Crit. Care"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/jth.15112","article-title":"Global Hemostatic Status in Patients with Acute-on-chronic Liver Failure and Septics without Underlying Liver Disease","volume":"19","author":"Lisman","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1055\/s-0040-1715102","article-title":"Thrombin Generation and Cirrhosis: State of the Art and Perspectives","volume":"46","author":"Lebreton","year":"2020","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1111\/jth.13278","article-title":"Procoagulant Changes in Fibrin Clot Structure in Patients with Cirrhosis Are Associated with Oxidative Modifications of Fibrinogen","volume":"14","author":"Hugenholtz","year":"2016","journal-title":"J. Thromb. Haemost."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/hep.30794","article-title":"Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial","volume":"71","author":"Kumar","year":"2019","journal-title":"Hepatology"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Cr\u0103ciun, R., Buliarc\u0103, A., Matei, D., Grap\u0103, C., Nenu, I., \u0218tef\u0103nescu, H., Mocan, T., Procope\u021b, B., and Sp\u00e2rchez, Z. (2024). Cirrhosis Progression Is Not Associated with Clinically Significant Alterations in Global Hemostasis Assessed by Thromboelastography. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216614"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"See\u00dfle, J., L\u00f6hr, J., Kirchner, M., Michaelis, J., and Merle, U. (2020). Rotational Thrombelastometry (ROTEM) Improves Hemostasis Assessment Compared to Conventional Coagulation Test in ACLF and Non-ACLF Patients. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01413-w"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2602\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:35:50Z","timestamp":1760114150000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2602"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,20]]},"references-count":103,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["diagnostics14222602"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14222602","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,20]]}}}