Decision-IQ: Are Your Patients at Risk of Bleeding? Managing Thrombocytopenia in Chronic Liver Disease
Which of the following procedures is associated with a low risk of bleeding for patients with chronic liver disease and thrombocytopenia?
A. Dental procedure
C. Radiofrequency ablation
D. Renal biopsy
Radiofrequency ablation, dental procedures, and renal biopsy are associated with a high risk of bleeding, whereas paracentesis is associated with a low risk.
Click the “Continue” button to learn more about managing thrombocytopenia in patients with chronic liver disease.
Patel IJ, et al. J Vasc Interv Radiol. 2012;23:727-773.
Terrault N, et al. Gastroenterology. 2018;155:705.
In this case-based activity, meet 2 patients with chronic liver disease and thrombocytopenia who are scheduled to undergo invasive procedures. As you move through this activity, you will:
- Be directed to useful resources to help you make management decisions for these patients
- See how your answers compare with your peers’
- Receive insights from gastroenterologists Steven Flamm, MD, and Nezam Afdhal, MD, on appropriate management for these patients
Nezam H. Afdhal, MD
Professor of Medicine
Harvard Medical School
Chief of Gastroenterology
Beth Israel Deaconess Medical Center
Steven L. Flamm, MD
Professor of Medicine and Surgery
Feinberg School of Medicine
Christie Avraamides, PhD
Clinical Content Manager
Laura Rafferty, ELS
Kathryn Schaefer, MSN, RN, CPHRM
Senior Manager, Accreditation and Compliance
East Lansing, MI
Upon completion, participants should be able to:
- Individualize treatment for patients with CLD and thrombocytopenia according to bleeding risk, platelet count, coagulopathy status, and procedure type
This activity is intended for hepatologists, liver specialists, and gastroenterologists.
Statement of Need
Thrombocytopenia occurs in approximately 64% to 84% of patients with cirrhosis or liver fibrosis and is associated with poor patient outcomes and increased mortality. Thrombocytopenia often delays or prevents patients from undergoing invasive diagnostic or therapeutic procedures because of the increased risk of bleeding. The treatment of thrombocytopenia is challenging for physicians as no guidelines exist on the minimum platelet count for which to apply prophylactic strategies to increase platelet numbers. In addition, data are limited in the literature regarding the optimal platelet count thresholds for specific procedures. Management strategies for thrombocytopenia have traditionally included platelet transfusions; however, this approach is associated with safety concerns. In 2018, two new thrombopoietin receptor agonists were approved by the United States Food and Drug Administration for the treatment of thrombocytopenia in patients with CLD who are scheduled to undergo procedures. Hepatologists, liver specialists, and gastroenterologists need to be up-to-date on recommended treatment approaches in order to optimize the management of thrombocytopenia and minimize bleeding risk in CLD patients who are undergoing scheduled procedures.
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This CME activity consists of a 0.5-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.
Initial Release Date: February 13, 2020
Expiration Date: February 12, 2021
Estimated Time to Complete This Activity: 30 minutes
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Nezam H. Afdhal, MD
Salary: Spring Bank Pharmaceuticals
Consulting fees/advisory boards: Gilead Sciences, Inc., Ligand Pharmaceuticals, Shionogi
Ownership interest (stocks/stock options – excluding mutual funds): Allurion Technologies, Spring Bank Pharmaceuticals
Steven L. Flamm, MD
Consulting fees/advisory boards: Dova Pharmaceuticals, Shionogi
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