Background: Acute variceal bleeding (AVB), a life-threatening complication of liver cirrhosis, can be effectively treated by endoscopy, but there is a risk of early rebleeding after endoscopic variceal treatment (EVT). Thrombocytopenia is the most common hemostatic abnormality in liver cirrhosis. However, it is still unclear about whether thrombocytopenia increases the failure of EVT in cirrhotic patients with AVB.
Objectives: We investigated the association between thrombocytopenia and the failure of EVT in cirrhotic patients with AVB.
Design: International multicenter, retrospective study.
Methods: Overall, 2467 cirrhotic patients with acute gastrointestinal bleeding who were enrolled into an international multicenter study between September 30, 2020 and June 30, 2023 were retrospectively screened. Thrombocytopenia was defined as platelet count below 150 × 109/L and further classified as mild (100 × 109/L-150 × 109/L), moderate (50 × 109/L-100 × 109/L), and severe (<50 × 109/L). A 1:1 propensity score matching (PSM) analysis was performed. Five-day failure to control bleeding was evaluated.
Results: Overall, 1079 patients were included, of whom 923 (85.5%) had thrombocytopenia, including mild (n = 241), moderate (n = 445), and severe (n = 237) thrombocytopenia. PSM analysis demonstrated that the rate of 5-day failure to control bleeding was not significantly different between patients with and without thrombocytopenia (mild: (12/153) 7.8% vs (7/153) 4.6%, p = 0.236; moderate: (9/155) 5.8% vs (7/155) 4.5%, p = 0.608; or severe: (5/132) 3.8% vs (7/132) 5.3%, p = 0.555).
Conclusion: Thrombocytopenia may not influence the efficacy of EVT in cirrhotic patients with AVB.
Keywords: endoscopy; failure to control bleeding; liver cirrhosis; thrombocytopenia; variceal bleeding.
Effect of decreased platelet count on the failure to control bleeding after endoscopic therapy in cirrhotic patients presenting with hematemesis or melena Why was the study done? Patients with cirrhosis who have hematemesis or melena are usually treated by endoscopy. However, in some patients, endoscopic therapy cannot completely control bleeding. Notably, cirrhotic patients may experience varying degrees of decreased platelet count, which may be associated with increased risk of bleeding. Until now, it is still unclear about whether decreased platelet count is associated with the failure to control bleeding after endoscopic therapy. What did the researchers do? Cirrhotic patients with acute gastrointestinal bleeding from an international multicenter database were screened. We adjusted confounding factors that may potentially influence the efficacy of endoscopic therapy to further clarify the effect of decreased platelet count on the failure of endoscopic therapy. What did the researchers find? Overall, 1079 patients were included, of whom 923 had decreased platelet count. Among them, platelet count was mildly, moderately, and severely decreased in 241, 445, and 237 patients, respectively. After eliminating the confounding factors, the incidence of failure of endoscopic therapy was not significantly different between patients with and without decreased platelet count. What do the findings mean? Decreased platelet count may not influence the efficacy of endoscopic therapy in cirrhotic patients presenting with hematemesis or melena.
© The Author(s), 2025.