Pregnancy in women with liver cirrhosis is associated with increased risk for complications: a systematic review and meta-analysis of the literature

Background Pregnancy and liver cirrhosis is a rare but increasing combination. Liver cirrhosis can raise the chance of maternal and fetal mortality and morbidity, although the exact risks remain unclear. Objective To provide a systematic literature review and meta-analysis on maternal, fetal and obstetric complications among pregnant women with liver cirrhosis. Search strategy We performed a systematic literature search in the databases PubMed/MEDLINE and EMBASE (Ovid) from inception through 25 January 2021. Selection criteria Studies including pregnancies with liver cirrhosis and controls were eligible. Data collection and analysis Two reviewers independently evaluated study eligibility. We used the random-effects model for meta-analysis. Main results Our search yielded 3118 unique papers. We included 11 studies, including 2912 pregnancies in women with cirrhosis from 1982-2020. Seven studies were eligible for inclusion in the meta-analysis. The overall maternal mortality rate was 0.89%. Maternal mortality and variceal hemorrhage decreased comparing recent and older studies. Most cases of maternal mortality due to variceal hemorrhage (70%) occurred during vaginal delivery. Pregnant women with liver cirrhosis had a higher chance of preterm delivery (OR 6.7 95% CI 5.1- 9.1), cesarean section (OR 2.6, 95% CI 1.7-3.9), preeclampsia (OR 3.8, 95% CI 2.2-6.5) and small for gestational age neonates (OR 2.6, 95% CI 1.6-4.2) compared to the general obstetric population. Subgroup-analyses could not be conducted. Conclusions Liver cirrhosis in pregnant women is associated with serious increases in maternal mortality and obstetric and fetal complications. Large international prospective studies are needed to identify risk factors for unfavorable outcome.

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Is it time to start COVID-19 vaccination in pregnant women?

Majalah Obstetri & Ginekologi ◽

10.20473/mog.v29i22021.84-90 ◽

2021 ◽

Vol 29 (2) ◽

pp. 84

Author(s):

Muhammad Ilham Aldika Akbar

Keyword(s):

Clinical Trial ◽

Pregnant Women ◽

Health Workers ◽

Promising Result ◽

Fetal Mortality ◽

Mortality And Morbidity ◽

Safety Issues ◽

Risk Of Mortality ◽

Increased Risk ◽

Adverse Pregnancy

HIGHLIGHTS1. Pregnant women infected with COVID 19 have a higher risk of maternal fetal mortality and morbidity.2. The available evidences show a safety profile in all type of COVID vaccines in pregnancy.3. Vaccination in pregnant women will decrease pregnancy complications, adverse pregnancy outcomes, and maternal death risk.4. The benefit of COVID vaccination exceeds the potential risk in pregnant women.5. Pregnant women are strongly recommended to receive COVID vaccine. ABSTRACTCOVID-19 pandemic has been lasting for years, and pregnant women encounter an increased risk of mortality and morbidity. Until now, vaccine COVID-19 has been developed and shows a promising result. Unfortunately, pregnant women are consistently excluded from receiving a new vaccine. Because pregnant women are excluded from participating in a clinical trial of vaccines related to safety issues, this exclusion cycle prevents pregnant women from receiving the vaccine that may benefit them. In this review article, the author provides evidence, data, and the reason why vaccination of pregnant women should be started in Indonesia, at least in a clinical trial, especially for health workers and women with comorbidities.

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MO817ALDOSTERONE ANTAGONISTS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE REQUIRING DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Takeshi Hasegawa ◽

Hiroki Nihiwaki ◽

Erika Ota ◽

William Levack ◽

Hisashi Noma

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Standard Care ◽

Meta Analysis ◽

Cardiovascular Death ◽

Aldosterone Antagonists ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Increased Risk

Abstract Background and Aims Patients with chronic kidney disease (CKD) undergoing dialysis are at a particularly high risk of cardiovascular mortality and morbidity. This systematic review and meta-analysis aimed to evaluate the benefits and harms of aldosterone antagonists, both non-selective (spironolactone) and selective (eplerenone), in comparison to control (placebo or standard care) in patients with CKD requiring haemodialysis or peritoneal dialysis. Method We searched the Cochrane Kidney and Transplant Register of Studies up to 29 July 2019 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. We included individual and cluster randomised controlled trials (RCTs), cross-over trials, and quasi-RCTs that compared aldosterone antagonists with placebo or standard care in patients with CKD requiring dialysis. We used a random-effects model meta-analysis to perform a quantitative synthesis of the data. We used the I2 statistic to measure heterogeneity among the trials in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes with their 95% confidence interval (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Results We included 16 trials (14 parallel RCTs and two cross-over trials) involving a total of 1,446 patients. Among included studies, 13 trials compared spironolactone to placebo or standard care and one trial compared eplerenone to a placebo. Most studies had an unclear or high risk of bias. Compared to control, aldosterone antagonists reduced the risk of all-cause death for patients with CKD requiring dialysis (9 trials, 1,119 patients: RR 0.45, 95% CI 0.30 to 0.67; moderate certainty of evidence). Aldosterone antagonist also decreased the risk of death due to cardiovascular disease (6 trials, 908 patients: RR 0.37, 95% CI 0.22 to 0.64; moderate certainty of evidence) and cardiovascular and cerebrovascular morbidity (3 trials, 328 patients: RR 0.38, 95% CI 0.18 to 0.76; moderate certainty of evidence). While aldosterone antagonists had an apparent increased risk of gynaecomastia compared with control (4 trials, 768 patients: RR 5.95, 95% CI 1.93 to 18.3; moderate certainty of evidence), the elevated risk of hyperkalaemia due to aldosterone antagonists was uncertain (9 trials, 981 patients: RR 1.41, 95% CI 0.72 to 2.78; low certainty of evidence). Conclusion Based on moderate certainty of the evidence, aldosterone antagonists could reduce the risk of all-cause and cardiovascular death and morbidity due to cardiovascular and cerebrovascular disease but increase the risk of gynaecomastia in patients with CKD requiring dialysis.

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Modern statin therapy in clinical practice: The lower the better

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1302104s ◽

2013 ◽

Vol 141 (1-2) ◽

pp. 104-106 ◽

Cited By ~ 1

Author(s):

Edita Stokic

Keyword(s):

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Statin Therapy ◽

Meta Analysis ◽

Ischemic Heart ◽

Mortality And Morbidity ◽

Increased Risk ◽

Coronary Events ◽

Risk Treatment

Lipid and lipoprotein disorders are well known risk factors for atherosclerosis and its complications. The level of atherogenic LDL-cholesterol (LDL-C) is directly related to an increased risk of occurrence and progression of ischemic heart disease. Epidemiological and clinical studies have shown that the use of statin therapy to decrease LDL-C can significantly reduce the incidence of mortality, major coronary events and the need for revascularization procedures in the different groups of patients. The findings of a large meta-analysis conducted by the Cholesterol Treatment Trialists? (CTT) collaborators showed that every 1.0 mmol/l reduction of atherogenic LDL-C is associated with a 22% reduction in cardiovascular diseases mortality and morbidity. However, despite the impressive results of the benefits of statin therapy, the EUROASPIRE study showed that about 50% of patients with ischemic heart disease did not achieve target LDL-C levels. According to the new ESC/EAS Guidelines for the Management of Dyslipidaemias in patients with a very high cardiovascular risk, treatment goal should be to decrease LDL-C below 1.8 mmol/l or ?50% of initial values. In the majority of patients that can be achieved by statin therapy. For this reason an adequate choice of statins is of crucial importance, whereby the needed reduction in atherogenic LDL-C, after the identification of its target level based on the assessment of total cardiovascular risk, can be achieved.

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The Relationship between Use of Low Molecular Weight Heparin during Pregnancy and Risk of Peripartum Adverse Events: A Meta-Analysis

Annals of Hematology & Oncology ◽

10.26420/annhematoloncol.2021.1372 ◽

2021 ◽

Vol 8 (11) ◽

Author(s):

Xiaorong Y ◽

◽

Shan L ◽

Shengji S ◽

Tao S ◽

...

Keyword(s):

Molecular Weight ◽

Adverse Events ◽

Pregnant Women ◽

Low Molecular Weight Heparin ◽

Meta Analysis ◽

Cochrane Library ◽

Premature Delivery ◽

Low Molecular Weight ◽

Significant Difference ◽

Fetal Complications

Introduction: To summarize the trials investigated on relationship between low molecular weight heparin use during pregnancy and peripartum adverse events. Meta-analysis was performed to evaluate the effect of Low Molecular Weight Heparin (LMWH) on maternal and fetal complications. Methods: Electronic research was performed in Cochrane Library, MEDLINE and EMBASE through October 2020. The primary outcome was the incidence of maternal and fetal complications during peripartum period. RevMan 5.3 was used for data analysis. Results: 11 articles were finally included. Meta-analysis showed there was no significant difference in abortion, premature delivery, stillbirth, preeclampsia and postpartum hemorrhage events between pregnant women who used LMWH and those who not. Conclusion: Using LMWH in pregnant women does not increase pregnancy related maternal and fetal complications.

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Case Report on Pregnancy with Lupus Nephritis Type IV with Hypothyroidism – A Clinical Vignette

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/52 ◽

2021 ◽

Vol 8 (05) ◽

pp. 272-274

Author(s):

Abirbhab Pal

Keyword(s):

Lupus Nephritis ◽

Lupus Erythematosus ◽

First Trimester ◽

The Body ◽

Fetal Mortality ◽

Thyroid Disorder ◽

Multisystem Disease ◽

Mortality And Morbidity ◽

Multiple Systems ◽

Increased Risk

Lupus is a multisystem disease affecting almost all systems including the immune system of our body. Its aetiology is not known. Lupus involving kidneys causes lupus nephritis and adds more complications in the multisystem disease. Lupus or systemic lupus erythematosus (SLE) is a multifactorial chronic disease involving multiple systems of the body. It is autoimmune1 in nature. There is increase in maternal and fetal risk of mortality and morbidity in lupus with pregnancy. The rate of pregnancy loss is 1.7 %2 in active SLE during initial first trimester and the most common adverse morbidity causing factor of fetomaternal side.3 There can be an increase in fetal mortality and morbidity associated with lupus nephritis.4,5 There is increased risk of intrauterine growth restriction (IUGR) / neonatal lupus / gestational diabetes mellitus / osteoporosis / HELLP syndrome / preeclampsia. Associated thyroid disorder is increased with preterm pregnancy.

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Pharmacotherapy of liver cirrhosis and its complications

Medicine of Ukraine ◽

10.37987/1997-9894.2021.2(248).229010 ◽

2021 ◽

pp. 23-27

Author(s):

T. M. Bentsa

Keyword(s):

Liver Cirrhosis ◽

Spontaneous Bacterial Peritonitis ◽

Hepatorenal Syndrome ◽

Beta Blockers ◽

Bleeding Risk ◽

Refractory Ascites ◽

Variceal Hemorrhage ◽

Bacterial Peritonitis ◽

Treatment And Prevention ◽

Increased Risk

This article provides information about the pharmacotherapy of liver cirrhosis (LC) and its complications, such as variceal hemorrhage, ascites, increased risk of bacterial infection, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome LC is a major healthcare problem and is associated with an increased mortality due to the development of complications. LC is currently the 11th most common cause of death globally. Prognosis of LC is highly variable and influenced by several variables, such as etiology, severity of liver disease, presence of complications and comorbidities. In advanced cirrhosis, survival decreases to one or two years. Pharmacotherapy for LC should be implemented in accordance with up-to-date guidelines and in conjunction with aetiology management, nutritional optimisation and patient education. The main treatment of uncomplicated ascites is diuretics such as spironolactone in combination with a loop diuretic. For treatment refractory ascites vasoconstrictors and albumin are recommended. Antibiotics play a well-established role in the treatment and prevention of spontaneous bacterial peritonitis. For hepatorenal syndrome, the administration of vasopressor terlipressin and albumin is recommended. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices). A shunt (TIPS) is used to treat severe or repeat variceal hemorrhage or refractory ascites. Non-selective beta-blockers effectively reduce variceal re-bleeding risk in LC patients with moderate/large varices. Thus, the treatment of LC as one of the most formidable multiorgan pathologies involves a comprehensive approach aimed at the correction of the main pathology and the treatment and prevention of its complications.

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Risk Factors associated with Fetal and Pregnancy Complications in Palestine

10.21203/rs.3.rs-511095/v1 ◽

2021 ◽

Author(s):

Sana ’ Al-Aqqad ◽

Nihal Al-Natour ◽

Mariam Al-Tell

Keyword(s):

Risk Factors ◽

Health Care ◽

Primary Health Care ◽

Pregnant Women ◽

Gestational Age ◽

Pregnancy Complications ◽

Health Care Clinics ◽

Primary Health ◽

Increased Risk ◽

Fetal Complications

Abstract Background: Complications observed during pregnancy affect both mother and fetus, and are more commonly observed among pregnant women from developing countries. The study aims to identify the most common pregnancy and fetal complications during pregnancy, and associated risk factors with these complications. Methods: A longitudinal study was conducted from September 2017 to July 2018 among pregnant women attending and registering in primary health care clinics of the Palestinian Ministry of Health in Nablus city. Data were collected through interviews and by reviewing medical records. Women were followed up during their regular visits to the primary health care clinics. Any complication affecting either the fetus or the mother during the pregnancy period was recorded. Binary logistic regression was used to identify independent risk factors for pregnancy and fetal complications. Results: A total of 380 pregnant women were included in the study. The most common complications seen among women during pregnancy were preterm labor (PTL) (11.3%), followed by an equal number of gestational diabetes (GDM) and pregnancies induce hypertension (PIH), i.e. (7.9%). Large for gestational age (LGA) (11.6 %) and small for gestational age (SGA) (10.5%) were the most commonly observed fetal complications. Pregnant women living in camps (O.R 2.35, 95% [CI] 1.02- 5.45), nulliparity (O.R 14.9, 95% [CI] 1.09-202.5) and low parity women (O.R 16.8, 95% [CI] 1.47- 192.5) were at higher risk of having pregnancy complications. However, lower risk was noticed between women with gravida 4 (O.R 0.11, 95% [CI] 0.03-0.47) compared to women having more than 6 pregnancies. Age younger than 41 years was a protective factor against fetal complications, while parity (≤ 6 parities) especially 4 to 6 parities (OR 36.17; 95% CI 4.88-268) and active smoking mothers (OR 1.25; 95% CI 1.0-3.07) were identified as risk factors that are associated with an increased risk of fetal complications. Conclusions: Fetal and pregnancy-related complications are prevalent among Palestinian pregnant women. Increasing the awareness and improving the understanding of the identified risk factors related to these complications among the public, and specifically, females may help to reduce the prevalence of these conditions and the associated risk of these complications.

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Maternal risk factors and fetal outcome in patients of abruption placentae.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3744 ◽

2020 ◽

Vol 27 (03) ◽

pp. 613-617

Author(s):

Humaira Tabassum ◽

Memoona Faiyaz ◽

Aasma Hanif ◽

Uzma Fahim ◽

Areeba Aftab

Keyword(s):

Risk Factors ◽

Perinatal Mortality ◽

Placental Abruption ◽

Tertiary Care ◽

Case Series ◽

Fetal Mortality ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Increased Risk ◽

Fetal Complications

Abruption placentae are a major cause of maternal and perinatal morbidity and mortality. Placental abruption is due to the rupture of the uterine spiral artery. Bleeding into decidua leads to separation of the placenta. There are many major maternal and fetal complications associated with placental abruption. Objectives: To assess the maternal risk factors, perinatal mortality and morbidity in relation to the severity of placental abruption. Study Design: Descriptive case series. Setting: Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore for one year. Period: From Jan 2016 to Dec 2016. Material & Methods: Hundred females were included with placental abruption and were followed-up till delivery. At the time of delivery maternal and fetal complications were noted. Results: Mean age of females was 29.24 + 3.58years. The mean gestational age at delivery was 32.95+3.12 weeks. About 64% underwent vaginal delivery while 36% underwent cesarean section. Among pre-disposing factors increased risk of anemia i.e. 46%, hypertension was found in 28%, multiple pregnancies with 18% and polyhydromnias were found in 8%. The incidence of fetal mortality was 58% and only 42% were born alive at time of delivery. Fetal morbidity is analyzed, 95.23% were in need of resuscitation, admission to nursery was done in 95.23%, neonatal jaundice was seen in 80.95%, anemia in 71.42% and respiratory problems were found in 85.71%. APGAR score at 5 minutes among 21 alive born fetuses was <8 in 85.71%. Conclusion: Resultantly maternal morbidity and perinatal mortality is significant, and this calls for early detection, regular visits, and special surveillance. There should be timely referral to tertiary care center where antenatal care plays an important role in decreasing the incidence of abruption placenta.

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Diabetes in Pregnancy and Risk of Antepartum Depression: A Systematic Review and Meta-Analysis of Cohort Studies

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17113767 ◽

2020 ◽

Vol 17 (11) ◽

pp. 3767 ◽

Cited By ~ 1

Author(s):

Kai Wei Lee ◽

Siew Mooi Ching ◽

Navin Kumar Devaraj ◽

Seng Choi Chong ◽

Sook Yee Lim ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Cohort Studies ◽

Pregnant Women ◽

Meta Analysis ◽

Diabetes In Pregnancy ◽

Antepartum Depression ◽

Increased Risk ◽

In Pregnancy

Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg’s tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251–1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205–1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736–2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.

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A Systematic Review and Meta-Analysis of Safety and Efficacy for Pre-Procedural Use of Thrombopoietin Receptor Agonists in Hepatic Cirrhosis Patients

Blood ◽

10.1182/blood-2019-132063 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1094-1094

Author(s):

Kunhwa Kim ◽

Faustine Ong ◽

Gabor Varadi ◽

Sorab Gupta ◽

Vinicius Machado Jorge

Keyword(s):

Liver Cirrhosis ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Risk Ratio ◽

Meta Analysis ◽

Statistical Significance ◽

P Value ◽

Receptor Agonists ◽

Vein Thrombosis ◽

Increased Risk

Introduction Thrombocytopenia is common in liver cirrhosis patients, which often complicates with patients' frequent issue with gastrointestinal bleeding and procedural needs. Based on biologic understanding of decreased thrombopoietin(TPO) level in liver cirrhosis patients, use of TPO agonists in liver cirrhosis have been actively studied. Over the period of time, new studies have come out about 2 FDA-approved TPO agonists, Avatrombopag and Lusutrombopag, for prophylaxis before procedure in liver cirrhosis patients with thrombocytopenia. In the past, there have raised concerns of increased risk of portal vein thrombosis and other thrombotic risks in other agents. In our study, we aimed to study the effectiveness and safety of TPO receptor agonists for pre-procedural use in patients with liver cirrhosis. Study design Study was conducted from August 2018 to July 2019. Previous studies were identified through database searching MEDLINE, CENTRAL, Clinicaltrial.gov and google search. Randomized clinical trials with active treatment arm with TPO receptor agonists in the use of liver cirrhosis patients, with intention of pre-procedural prophylaxis, and having placebo for direct comparisons were included. One of the major exclusions was TPO receptor agonists to increase platelet counts for anti-viral treatment in cirrhosis patients. 14 studies were identified. Studies were reviewed and eligibility was determined by two independent clinically trained researchers. 5 duplicated studies were removed, and in total of 7 studies were included for quantitative and qualitative analysis. Details of studies were collected by 2 independent researchers and compared. When there is a discrepancy, repeat review of the study was conducted. Studies were conducted or published from 2012 to 2018. 1 trial from Eltrombopag, 3 trials from Avatrombopag, and 3 trials from Lusutrombopag were included. Result Characteristics of included studies are summarized in table 1. Our studies found that 5.5(95% CI : 4.35-7.15) times higher risk ratio(RR) of reaching platelet target before procedure compared to placebo. Target platelet number goal was 50,000 to 80,000 depending on the study. Studies showed homogenous result with I-squared was 30.8% and q-statistics of p-value 0.193.(Figure 1) Subgroup analysis by FDA-approved medication of Avatrombopag and Lusutrombopag showed statistically significant higher risk ratio of 4.74(3.36-6.68) and of 5.52(3.65-8.34) each compared to placebo. Risk ratio for preventing platelet transfusion was not able to be calculated with heterogeneity of study with I-square higher than 90%. Lusutrombopag study showed significant benefits (RR 6.33, 95% CI 2.95-13.58) with heterogeneity inside the same medications, which might be explained with different doses in studies. No statistical significance in risk ratio in a study with Avatrombopag. Subgroup analysis limited to phase 3 studies showed risk ratio of preventing transfusion of 2.87(95% CI 2.15-3.82) but heterogeneity with q-statistics of p-value at 0.029. Relative risk for adverse event related to portal vein thrombosis was not statistically significant with RR of 0.99(95% CI : 0.35-2.85) in total of 1,229 patients.(Figure 2) Study result was homogenous result by I-square 0%, q-statistics of p-value 0.794. Other severe adverse events, major bleeding risk, overall thrombosis risk were not statistically significant. Only increased risk without statistical significance was reported in trail with Eltrombopag which was early terminated. Conclusion Our meta-analysis of pre-procedural use of TPO agonist in liver cirrhosis patients showed statistically significant benefit of reaching platelet count goal by 5.58 times with risk ratio, but no benefit of preventing transfusion. Compared to prior studies including use of TPO agonists for Interferon-Ribavirin treatment, meta-analysis limited to pre-procedural use did not show statistically significant increase in portal vein thrombosis. Serious adverse events including thrombosis events and bleeding risk were not statistically significant. Most studies described that portal-vein thrombosis events were often related to high platelet counts about 200,000 and longer use of TPO agonist. In current era with lesser use of Interferon and Ribavirin as an anti-viral therapy, TPO agonists use in setting of pre-procedure mostly with lower platelet targets can be safely used. Disclosures No relevant conflicts of interest to declare.

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