Large-Volume Paracentesis in Patients with Cirrhotic Ascites: Does It Increase the Risk of Serious Bleeding and the Need for Transfusion?


Background: Liver cirrhosis is the most common cause of ascites. For cirrhotic ascites that does not respond to diuretics and salt restriction, large-volume paracentesis is an alternative option. Methods: A retrospective cohort study of patients admitted to the Day care unit at King Abdulaziz University Hospital for therapeutic paracentesis of cirrhotic ascites was performed from March 2013-April 2014. The demographic data and results, including the platelet count, hemoglobin level, prothrombin time (PT), international normalized ratio (INR), serum creatinine, serum albumin, and bilirubin levels, were recorded. We recorded all of the bleeding episodes. Results: We recorded 118 admissions for 13 patients. Nine of them were male (69.2%), and the mean age was 58.6 ± 15.8 years. All patients had a Child-Pugh score of C. The platelet count was lower than normal for 78 admissions (66.1%), and the PT was prolonged for 99 admissions (84%). Three episodes of bleeding occurred in our cohort, all of which were mild and controlled by the local application of pressure. One patient required a platelet transfusion for severe thrombocytopenia, low platelets count was associated with elevated creatinine and low albumin levels (P = 0.014 and 0.003, respectively). Similarly, a prolonged PT was associated with low albumin, high bilirubin, low platelet, and high creatinine levels (P = 0.013, < 0.001, = 0.006, and < 0.001, respectively). Conclusions: Large-volume paracentesis is associated with only a small risk of bleeding in patients with cirrhotic ascites, and a transfusion of fresh frozen plasma (FFP) and platelets is not needed for the majority of patients.

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Fallatah, H. (2015) Large-Volume Paracentesis in Patients with Cirrhotic Ascites: Does It Increase the Risk of Serious Bleeding and the Need for Transfusion?. Open Journal of Blood Diseases, 5, 43-47. doi: 10.4236/ojbd.2015.54007.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Runyon, B.A. (1994) Care of Patients with Ascites. The New England Journal of Medicine, 330, 337-342.
[2] Hou, W. and Sanyal, A.J. (2009) Ascites: Diagnosis and Management. Medical Clinics of North America, 93, 801-817.
[3] Moore, K.P. and Aithal, G.P. (2006) Guidelines on the Management of Ascites in Cirrhosis. Gut, 55, vi1-vi12.
[4] Singhal, S., Baikati, K.K., Jabbour, I.I. and Anand, S. (2012) Management of Refractory Ascites. American Journal of Therapeutics, 19, 121-132.
[5] Senousy, B.E. and Draganov, P.V. (2009) Evaluation and Management of Patients with Refractory Ascites. World Journal of Gastroenterology, 15, 67-80.
[6] Blonski, W., Siropaides, T. and Reddy, K.R. (2007) Coagulopathy in Liver Disease. Current Treatment Options in Gastroenterology, 10, 464-473.
[7] Caldwell, S.H. (2014) Management of Coagulopathy in Liver Disease. Gastroenterology and Hepatology, 10, 330-332.
[8] Amarapurkar, R.D. and Amarapurkar, D.N. (2011) Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis. International Journal of Hepatology, 2011, Article ID: 695470.
[9] Lin, C.H., Shih, F.Y., Ma, M.H., Chiang, W.C., Yang, C.W. and Ko, P.C. (2005) Should Bleeding Tendency Deter Abdominal Paracentesis? Digestive and Liver Disease, 37, 946-951.
[10] De Gottardi, A., Thévenot, T., Spahr, L., Morard, I., Bresson-Hadni, S., Torres, F., Giostra, E. and Hadengue, A. (2009) Risk of Complications after Abdominal Paracentesis in Cirrhotic Patients: A Prospective Study. Clinical Gastroenterology and Hepatology, 7, 906-909.
[11] Wiese, S.S., Mortensen, C. and Bendtsen, F. (2011) Few Complications after Paracentesis in Patients with Cirrhosis and Refractory Ascites. Danish Medical Bulletin, 58, A4212.
[12] Mannucci, P.M. and Tripodi, A. (2013) Liver Disease, Coagulopathies and Transfusion Therapy. Blood Transfusion, 11, 32-36.
[13] Amitrano, L., Guardascione, M.A., Brancaccio, V. and Balzano, A. (2002) Coagulation Disorders in Liver Disease. Seminars in Liver Disease, 22, 83-96.
[14] Lisman, T. and Porte, R.J. (2010) Rebalanced Hemostasis in Patients with Liver Disease: Evidence and Clinical Consequences. Blood, 116, 878-885.
[15] Peck-Radosavljevic, M. (2007) Review Article: Coagulation Disorders in Chronic Liver Disease. Alimentary Pharmacology & Therapeutics, 26, 21-28.
[16] Nasr, G., Hassan, A., Ahmed, S. and Serwah, A. (2010) Predictors of Large Volume Paracantesis Induced Circulatory Dysfunction in Patients with Massive Hepatic Ascites. Journal of Cardiovascular Disease Research, 1, 136-144.
[17] Wang, S.S., Chen, C.C., Chao, Y., Wu, S.L., Lee, F.Y., Lin, H.C., Kong, C.W., Tsai, Y.T. and Lee, S.D. (1996) Sequential Hemodynamic Changes for Large Volume Paracentesis in Post-Hepatitic Cirrhotic Patients with Massive Ascites. Proceedings of the National Science Council, Republic of China, Part B, 20, 117-122.
[18] O’Leary, J.G., Lepe, R. and Davis, G.L. (2008) Indications for Liver Transplantation. Gastroenterology, 134, 1764-1766.
[19] Kochhar, P.K., Ghosh, P. and Kochhar, R.S. (2012) Effect of Blood Transfusion on Subsequent Organ Transplantation. In: Kochhar, P., Ed., Blood Transfusion in Clinical Practice, Chap. 15, InTech, Rikeka, Croatia.
[20] Scornik, J.C. and Meier-Kriesche, H.U. (2011) Blood Transfusions in Organ Transplant Patients: Mechanisms of Sensitization and Implications for Prevention. American Journal of Transplantation, 11, 1785-1791.

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