Transjugular Intrahepatic Portosystemic Shunt for Variceal Bleeding in Cirrhotic Patients with Severe Thrombocytopenia

Abstract

AbstractBackgroundTo compare all-cause rebleeding rates and mortality after transjugular intrahepatic portosystemic shunt (TIPS) between severe thrombocytopenia (TCP) and non-severe TCP patients admitted for variceal bleeding.MethodsBetween January 2017 and June 2020, patients with severe TCP (platelets < 50 × 109/L) who received TIPS procedures for variceal bleeding at three medical centers were included. As controls, non-severe TCP patients were matched (1:1) by age, viral hepatitis, splenectomy, white blood cell, prothrombin time, international normalized ratio, total bilirubin, and acute variceal bleeding. Primary outcome was 6-week all-cause rebleeding. Secondary outcomes included 1-year all-cause rebleeding, 30-day and 1-year all-cause mortality and complications occurred during or after TIPS creation.ResultsA total of 373 patients were included in the study, with 84 patients in each cohort after matching. All-cause rebleeding rates at 6-week and 1-year post-TIPS were similar in cohorts with severe versus non-severe TCP (6.0% vs 4.8% at 6-week and 10.7% vs 10.7% at 1-year; P = 0.962; HR: 1.023; 95% CI, 0.406–2.577). One-year all-cause mortality was also comparable between the two cohorts (10.7% vs 9.5%, P = 0.754; HR: 1.164; 95% CI, 0.449–3.018). The comparison of 30-day post-TIPS mortality was inconclusive due to the relatively small number of positive outcome events. A trend toward slightly higher major complications was observed in the severe TCP cohort (8.3% vs 2.4%, P = 0.078).ConclusionsCompared with non-severe TCP, severe TCP did not increase the risk of early and late rebleeding after TIPS in patients with variceal bleeding.