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Platelet Count Does Not Predict Bleeding in Cirrhotic Patients: Results from the PRO-LIVER Study

The American Journal of Gastroenterology volume 113, pages 368375 (2018) | Download Citation



Thrombocytopenia is a hallmark for patients with cirrhosis and it is perceived as a risk factor for bleeding events. However, the relationship between platelet count and bleeding is still unclear.


We investigated the relationship between platelet count and major or clinical relevant nonmajor bleedings during a follow-up of 4 years.


A total of 280 cirrhotic patients with different degrees of liver disease (67% males; age 64±37 years; 47% Child–Pugh B and C) were followed up for a median of 1,129 (interquartile range: 800–1,498) days yielding 953.12 patient-year of observation. The annual rate of any significant bleeding was 5.45%/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. Platelet counts progressively decreased with the worsening of liver disease and were similar 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 any bleeding event. Conversely, prothrombin time-international normalized ratio was slightly higher in patients with overall or major bleeding. On Cox proportional hazard 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 overall bleeding events.


Platelet count does not predict unprovoked major or minor bleeding in cirrhotic patients.

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Author notes


  1. Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

    • S Basili
    • , G Talerico
    •  & F Violi
  2. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

    • V Raparelli
    •  & L Napoleone
  3. Clinica Medica I, Department of Internal Medicine S. Matteo, University Hospital Pavia, Pavia, Italy

    • G R Corazza
  4. Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy

    • F Perticone
  5. Department of Medicine, University of Padova, Padova, Italy

    • D Sacerdoti
  6. Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy

    • A Andriulli
  7. Department of Internal Medicine and Specialities, DIBIMIS, University of Palermo, Palermo, Italy

    • A Licata
  8. Unit of Internal Medicine 2, Department of Medical and Surgical Science for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy

    • A Pietrangelo
  9. Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Rome, Italy

    • A Picardi
  10. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    • G Raimondo


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Competing interests

Guarantor of the article: F. Violi, MD.

Specific author contributions: S. Basili: study design, patient recruitment, data analysis and interpretation, and writing the manuscript. V. Raparelli: data collection, patient recruitment, data analysis and interpretation, and writing the manuscript. L. Napoleone: patient recruitment and data entry. G. Talerico: patient recruitment and data entry. G.R. Corazza: patient recruitment and revision of the manuscript. F. Perticone, D. Sacerdoti, A. Andriulli, A. Licata, A. Pietrangelo, A. Picardi, and G. Raimondo: patient recruitment and revision of the manuscript. F. Violi: study conception and design, data interpretation, and writing the manuscript. F. Violi had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Financial support: SAPIENZA University Research Project 2016.

Potential competing interests: None.

Corresponding author

Correspondence to F Violi.

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