AGA’s New Guidelines For Managing Patients With Cirrhosis

Source: Freepik

AGA, i.e., The American Gastroenterological Association, has issued a new set of guidelines to diagnose and manage coagulopathies in cirrhosis patients.

Apart from affecting body’s metabolism in general, cirrhosis also gives rise to severe coagulopathies. It is because liver synthesizes most of the clotting factors involved in the intrinsic pathway. These include Factor 2,7,9 and 10. Hence, liver damage significantly impacts the intrinsic coagulation cascade and renders the patients at a higher risk for bleeding disorders. This increases chances of patient morbidity while diagnosing and managing cirrhosis using various invasive procedures.

“Patients with cirrhosis typically have abnormal markers of coagulation, which in the past were interpreted as indicating a higher risk of bleeding.”

Dr. Robert S. O’Shea, MD, Cleveland Clinic.

To minimize the risk, AGA has recommended a new set of guidelines. These guidelines advocate against the employment of extensive pre-procedural testing for coagulation tendencies in such patients such as testing for Prothrombin Time (PT). Moreover, they highlight the importance of deploying various prophylactic treatments prior to subjecting such patients to common GI procedures.

Available in the American Gastroenterological Association’s own journal, Gastroenterology, the guidelines state:

1- Doctors should avoid extensive pre-procedural estimation of coagulation profile in patients with cirrhosis.

2-They should avoid frequent transfusions including those for plasma and platelets.

3- They should actively give prophylaxis for venous thromoboembolism to patients hospitalized with cirrhosis.

4-They should give anticougulants to treat portal vein thrombosis (PVT) in patients with cirrhosis.

In short, these new guidelines aim to reform testing protocols for such patients in order to minimize morbidity and mortality.


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