Hepatobiliary and Pancreatic Diseases International 2020-Jan
Preservation of platelet function in patients with cirrhosis and thrombocytopenia undergoing esophageal variceal ligation.
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METHODS
The assessment consisted of platelet count, antigen and activity of VWF and VWF-cleaving protease ADAMTS-13 activity, and a platelet adhesion and aggregation test simulating vascular flow in vivo (Impact-RⓇ) prior to EVL.RESULTS
Totally 111 patients were divided into three groups according to platelet count: (1) <50 × 109/L (n =38, 34.2%); (2) 50 × 109/L to 100 × 109/L (n = 47, 42.3%); and (3) >100 × 109/L (n = 26, 23.4%). No statistically significant difference was found in the aggregate size of platelets (group 1: 41.0 (31.8-67.3) µm2; group 2: 47.0 (33.8-71.3) µm2; and group 3: 47.0 (34.0-66.0) µm2; P = 0.60) and no significant correlation was found between aggregate size and platelet count (Spearman r = 0.07; P = 0.47). Surface coverage was 4.1% (2.8%-6.7%), 8.5% (4.0%-10.0%), and 9.0% (7.1%-12.0%) (P<0.001) in groups 1, 2 and 3, respectively and correlated with platelet count (Spearman r = 0.39; P<0.0001). There was no significant difference between groups in VWF or ADAMTS-13. Post-EVL bleeding occurred in six (5.4%) patients (n = 2 in group 1, n = 1 in group 2, and n = 3 in group 3; P = 0.32). Patients with bleeding had higher MELD scores [15.0 (11.3-20.3) versus 12.0 (10.0-15.0); P = 0.025], but no difference was demonstrated for platelet function parameters.