Effect of severe thrombocytopenia on bleeding in chronic liver disease after low risk surgical procedures. A meta-analysis

Thrombocytopenia is a frequent feature of patients with liver cirrhosis (LC); it is closely related to the degree of liver failure with lowest platelet count in patients with liver decompensation. Our metanalysis aimed to see if LC patients with platelet count 50 × 103/mm3, candidates for low-risk surgical interventions, are at higher risk of bleeding compared to patients with higher platelet count. The 4 studies ranged in size from a minimum of 150 patients to amaximum of 3117 patients with a total of 4944. Of the total 4944 subjects 491 had platelet count 50 × 103/mm3 and 4453 > 50 × 103/mm3. The incidence rate for bleeding was 3.01% and 1.97 % in the subjects with platelet count  or >50 × 103/mm3, respectively. No significant reduction of bleeding was observed between these 2 groups of patients in the overall analysis. In conclusion, this meta-analysis reports that in case of severe thrombocytopenia the bleeding risk of patients with chronic liver disease undergoing low-risk surgical intervention does not seem to be elevated suggesting caution in the therapeutic attempt to increase platelet count in this type of surgical intervention.