Risk of bleeding in end-stage liver disease patients: Undergoing cardiac catheterization

Ahmed M. Mahmoud, Islam Y. Elgendy, Calvin Y. Choi, Anthony A. Bavry

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Patients with end-stage liver disease frequently have baseline coagulopathies. The international normalized ratio is in common use for the estimation of bleeding tendency in such patients, especially those undergoing an invasive procedure like cardiac catheterization. The practice of international normalized ratio measurement—followed by pharmacologic (for example, vitamin K or fresh frozen plasma) or nonpharmacologic intervention—is still debatable. The results of multiple randomized trials have shown the superiority of the radial approach over femoral access in reducing catheterization bleeding. This reduction in bleeding in turn decreases the risk and cost of blood-product transfusion. However, there is little evidence regarding the use of the radial approach in the end-stage liver disease patient population specifically. In this review, we summarize the studies that have dealt with cardiac catheterization in patients who have end-stage liver disease. We also discuss the role of the current measurements that are used to reduce the risk of bleeding in these same patients.

Original languageEnglish (US)
Pages (from-to)414-418
Number of pages5
JournalTexas Heart Institute Journal
Issue number5
StatePublished - Oct 2015
Externally publishedYes


  • Blood coagulation disorders/complications
  • Cardiac catheterization/adverse effects
  • End-stage liver disease/complications
  • Factor VIIa/therapeutic use
  • International normalized ratio
  • Liver cirrhosis/blood/ complications
  • Radial artery
  • Vitamin K/therapeutic use

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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