Conflict of interest: Nothing to report.
Coronary Artery Disease
Cardiac catheterization in patients with end-stage liver disease: Safety and outcomes†
Article first published online: 15 APR 2010
Copyright © 2010 Wiley-Liss, Inc.
Catheterization and Cardiovascular Interventions
Volume 77, Issue 1, pages 45–48, 1 January 2011
How to Cite
Pillarisetti, J., Patel, P., Duthuluru, S., Roberts, J., Chen, W., Genton, R., Wiley, M., Candipan, R., Tadros, P. and Gupta, K. (2011), Cardiac catheterization in patients with end-stage liver disease: Safety and outcomes. Cathet. Cardiovasc. Intervent., 77: 45–48. doi: 10.1002/ccd.22591
- Issue published online: 15 APR 2010
- Article first published online: 15 APR 2010
- Accepted manuscript online: 15 APR 2010 12:00AM EST
- Manuscript Accepted: 27 MAR 2010
- Manuscript Received: 8 JAN 2010
- heart catheterization;
- bleeding risk
Introduction: Patients with end-stage liver disease (ESLD) awaiting transplant are at increased risk of bleeding. Nevertheless, these patients routinely undergo cardiac catheterization for various indications. Safety and outcomes of cardiac catheterization in these patients are not well reported. Methods: In a case–control study 43 patients with ESLD who underwent angiography for liver transplant work-up were compared to 43 age and gender-matched controls with no liver dysfunction. In-hospital outcomes and procedural variables were compared. Results: Patients with ESLD had a lower baseline hemoglobin (12.1 ± 2.1 vs. 13.7 ± 1.8, P < 0.0005), lower platelet counts (86.8 ± 66 vs. 247 ± 80, P < 0.0001) and higher international normalized ratio (INR) (1.4 ± 0.2 vs. 1.1 ± 0.2, P < 0.0001) than controls. Among ESLD group, five (11.6%) patients received platelet transfusions, one received blood transfusion, and three patients (7%) with INR > 1.6 received fresh frozen plasma (FFP) compared with none in the control group. Smaller size (four French) vascular sheaths were used more frequently in the group with ESLD (16% vs. 4%, P = 0.04). There were no significant vascular or bleeding complications in either group. Conclusions: Elective cardiac catheterization can be safely performed in patients with ESLD with outcomes (vascular and bleeding complications, length of hospital stay and in-hospital mortality) similar to patients without liver disease despite significant thrombocytopenia and elevated INR in patients with ESLD. Practices such as platelet transfusion for platelets <60,000 μL, prophylactic FFP transfusion for INR ≥≥ 1.6, less frequent use of antiplatelet therapy and more frequent use of smaller vascular sheaths may have contributed to the safety of cardiac catheterization in ESLD patients. © 2010 Wiley-Liss, Inc.