Agradecimentos: Gabrielle Laskey from University of Virginia, Charlottesville, Virginia; Jorge Martinez Morales, MD, from Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; J. Westley Heinle, MPH, and Breianna Hummer, MS, from Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Alex Burdzy, BS, from University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Maria Julia Gabriela Colossi from Division of Gastroenterology (Gastrocentro), Department of Internal Medicine, School of Medical Sciences of University of Campinas (UNICAMP), São Paulo, Brazil; Marina Sycheva from Wake Forest University School of Medicine, Atrium Health, Charlotte, North Carolina; Caroline Marcondes Ferreira, MSc, from University of São Paulo School of Medicine, São Paulo, Brazil; Hannah Amundson and Rehma Shabbir, MBBS, ACRP-CP, BS, from Baylor Scott and White Hospital, Dallas, Texas; Alfredo Servin-Caamaño, MD, from Hospital General de México "Dr. Eduardo Liceaga," La Salle Faculty of Medicine, Mexico City, Mexico; and Kamalpreet S. Hara, MBBS, from Mayo Clinic, Rochester, Minnesota. CRediT Authorship Contributions Nicolas M. Intagliata, MD, MS (Conceptualization: Lead; Investigation: Lead; Supervision: Lead; Writing – original draft: Lead; Writing – review editing: Lead). Robert S. Rahimi, MD, MSCR (Investigation: Supporting). Fatima Higuera-de-la-Tijera, MD, PhD (Investigation: Supporting). Douglas A. Simonetto, MD (Investigation: Supporting). Alberto Queiroz Farias, MD (Investigation: Supporting). Daniel F. Mazo, MD, PhD (Investigation: Supporting). Justin R. Boike, MD, MPH (Investigation: Supporting). Jonathan G. Stine, MD (Investigation: Supporting). Marina Serper, MD, MS (Investigation: Supporting). Gustavo Pereira, MD, PhD (Investigation: Supporting). Angelo Z. Mattos, MD, MSc, PhD (Investigation: Supporting). Sebastian Marciano, MD, MSc (Investigation: Supporting). Jessica P.E. Davis, MD, MSCR (Investigation: Supporting). Carlos Benitez, MD (Investigation: Supporting). Ryan Chadha, MD (Investigation: Supporting). Nahum Méndez-Sánchez, MD, MS, PhD (Investigation: Supporting). Andrew S. deLemos, MD (Investigation: Supporting). Arpan Mohanty, MBBS, MD (Investigation: Supporting). Melisa Dirchwolf, MD (Investigation: Supporting). Brett E. Fortune, MD (Investigation: Supporting). Patrick G. Northup, MD (Investigation: Supporting). James T. Patrie, MS (Data curation: Supporting; Formal analysis: Supporting). Stephen H. Caldwell, MD (Investigation: Supporting). Funding None Ver menos

Abstract: Hospitalized patients with cirrhosis frequently undergo multiple procedures. The risk of procedural-related bleeding remains unclear, and management is not standardized. We conducted an international, prospective, multicenter study of hospitalized patients with cirrhosis undergoing nonsurgical procedures to establish the incidence of procedural-related bleeding and to identify bleeding risk factors. Hospitalized patients were prospectively enrolled and monitored until surgery, transplantation, death, or 28 days from admission. The study enrolled 1187 patients undergoing 3006 nonsurgical procedures from 20 centers. A total of 93 procedural-related bleeding events were identified. Bleeding was reported in 6.9% of patient admissions and in 3.0% of the procedures. Major bleeding was reported in 2.3% of patient admissions and in 0.9% of the procedures. Patients with bleeding were more likely to have nonalcoholic steatohepatitis (43.9% vs 30%) and higher body mass index (BMI; 31.2 vs 29.5). Patients with bleeding had a higher Model for End-Stage Liver Disease score at admission (24.5 vs 18.5). A multivariable analysis controlling for center variation found that high-risk procedures (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.44-8.84), Model for End-Stage Liver Disease score (OR, 2.37; 95% CI, 1.46-3.86), and higher BMI (OR, 1.40; 95% CI, 1.10-1.80) independently predicted bleeding. Preprocedure international normalized ratio, platelet level, and antithrombotic use were not predictive of bleeding. Bleeding prophylaxis was used more routinely in patients with bleeding (19.4% vs 7.4%). Patients with bleeding had a significantly higher 28-day risk of death (hazard ratio, 6.91; 95% CI, 4.22-11.31).Procedural-related bleeding occurs rarely in hospitalized patients with cirrhosis. Patients with elevated BMI and decompensated liver disease who undergo high-risk procedures may be at risk to bleed. Bleeding is not associated with conventional hemostasis tests, preprocedure prophylaxis, or recent antithrombotic therapy Ver menos