Paracentesis-related bleeding complications and associated risk factors in patients with liver cirrhosis

Abstract

Background: Ascites is the most frequent complication in liver cirrhosis and often requires paracentesis. The aim of this study was to evaluate the rate of paracentesis-related bleeding complications and the associated risk factors.

Patients and methods: An observational, unicentric, retrospective study to analyze paracentesis-related bleeding complications in the 7 days after the procedure. All paracentesis procedures performed at our centre from January 1998 to December 2018 were analyzed. A propensity score matching was performed. Data were obtained from patients' clinical records.

Results: 1137 patients with a total of 11,043 paracentesis procedures were analyzed. Patients were on antiplatelet treatment for 316 procedures (2.9%) and on anticoagulant treatment for 585 (5.3%). Thirty-six paracentesis procedures (0.3%) had a major bleeding complication, with a mortality rate of 0.01%. The group with paracentesis-related bleeding had an international normalized ratio (INR) and prothrombin time and more impaired liver function than those without bleeding. No differences were observed in bleeding events according to anticoagulant and antiplatelet treatment. Anticoagulant and antiplatelet treatments seem not to increase the risk of bleeding complications after paracentesis.

Conclusion: Paracentesis is a safe procedure, even in patients on antiplatelet and anticoagulant treatment. The risk factors associated with bleeding complications were number of previous paracentesis, increased INR and liver impairment.

Keywords: Anticoagulant treatment; Antiplatelet treatment; Bleeding complication; Cirrhosis; Cirrosis; Complicación hemorrágica; Paracentesis; Tratamiento antiagregante; Tratamiento anticoagulante.