Platelet count does not predict bleeding in cirrhotic patients: results from the PRO-LIVER Study

OBJECTIVES: Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship betweenplatelet count and bleeding is still unclear.METHODS: We investigated the relationship between platelet count and major orclinical relevant nonmajor bleedings during a follow-up of ∼4 years.RESULTS: A total of 280 cirrhotic patients with different degrees of liverdisease (67% males; age 64±37 years; 47% Child-Pugh B and C) were followed up fora median of 1,129 (interquartile range: 800-1,498) days yielding 953.12patient-year of observation. The annual rate of any significant bleeding was5.45%/year (3.57%/year and 1.89%/year for major and minor bleeding,respectively). Fifty-two (18.6%) patients experienced a major (n=34) or minor(n=18) bleeding event, predominantly from gastrointestinal origin. Plateletcounts progressively decreased with the worsening of liver disease and weresimilar in patients with or without major or minor bleeding: a platelet count ≤50× 103/μl was detected in 3 (6%) patients with and in 20 (9%) patients without anybleeding event. Conversely, prothrombin time-international normalized ratio wasslightly higher in patients with overall or major bleeding. On Cox proportionalhazard analysis, only a previous gastrointestinal bleeding (hazard ratio (HR):1.96; 95% confidence interval: 1.11-3.47; P=0.020) and encephalopathy (HR: 2.05; 95% confidence interval: 1.16-3.62; P=0.013) independently predicted overallbleeding events.CONCLUSIONS: Platelet count does not predict unprovoked major or minor bleedingin cirrhotic patients.