{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:39:01Z","timestamp":1787027941190,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Current guidelines advise against platelet transfusion prior to emergent esophageal variceal band ligation (EVL) in cirrhotic patients with platelet counts below 50 \u00d7 103\/\u03bcL. However, recommendations for elective EVL remain unclear. This study evaluates the outcomes of cirrhotic patients undergoing outpatient EVL. Methods: Adult patients aged 18 years and older diagnosed with cirrhosis, with or without significant thrombocytopenia (&lt;50 \u00d7 103\/\u03bcL), were identified using the TriNetX database. Patients who received platelet transfusions within one week prior to or on the day of EVL were excluded. Cirrhotic patients with significant thrombocytopenia undergoing outpatient elective EVL were categorized into two cohorts: (1) those with platelet counts between 30 and 49 \u00d7 103\/\u03bcL and (2) those with platelet counts \u226550 \u00d7 103\/\u03bcL. Propensity score matching (PSM) was employed to compare rates of post-EVL esophageal variceal bleeding and 14-day mortality between the two cohorts. Results: A total of 16,718 cirrhotic patients undergoing outpatient EVL were included in the analysis. Of these, 17.2% (n = 2874) had significant thrombocytopenia, while 82.8% (n = 13,844) had platelet counts \u226550 \u00d7 103\/\u03bcL. Two well-matched cohorts (2864 patients each) were created using 1:1 PSM. No statistically significant differences were observed between the groups regarding 14-day post-EVL esophageal variceal bleeding (13.7% vs. 15.2%; p = 0.12), 14-day mortality (5.7% vs. 5.0%; p = 0.28), and 28-day mortality (8.4% vs. 7.5%; p = 0.20). Conclusions: Elective EVL appears to be safe in cirrhotic patients with platelet counts as low as 30 \u00d7 103\/\u03bcL, challenging the current threshold of 50 \u00d7 103\/\u03bcL for platelet transfusion.<\/jats:p>","DOI":"10.3390\/diseases13020027","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T04:54:31Z","timestamp":1737608071000},"page":"27","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Outcomes of Outpatient Elective Esophageal Varices Band Ligation in Cirrhosis Patients with Significant Thrombocytopenia"],"prefix":"10.3390","volume":"13","author":[{"given":"Nisar","family":"Amin","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6518-3971","authenticated-orcid":false,"given":"Mark","family":"Ayoub","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julton","family":"Tomanguillo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0658-1857","authenticated-orcid":false,"given":"Harleen","family":"Chela","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6796-9359","authenticated-orcid":false,"given":"Veysel","family":"Tahan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0622-1704","authenticated-orcid":false,"given":"Ebubekir","family":"Daglilar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University, Charleston, WV 25304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"100449","DOI":"10.1016\/j.puhip.2023.100449","article-title":"Regional and sex inequalities of avoidable mortality in Italy: A time trend analysis","volume":"6","author":"Golinelli","year":"2023","journal-title":"Public Health Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"480","DOI":"10.21037\/atm.2019.08.34","article-title":"Inpatient burden of esophageal varices in the United States: Analysis of trends in demographics, cost of care, and outcomes","volume":"7","author":"Solanki","year":"2019","journal-title":"Ann. 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