skip to main content

GI Bleeding in Cirrhosis — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardEmergency MedicineGI Bleeding in CirrhosisRACP Adult Medicine

A 55-year-old woman with known liver cirrhosis presents with acute upper GI bleeding. She is haemodynamically stable. Platelet count is 55 × 10⁹/L, INR 1.9, and fibrinogen 1.2 g/L. Standard coagulation parameters were routinely corrected with FFP and platelets in the past. What is the current evidence-based approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — No routine correction of INR or platelets – proceed to endoscopy

In cirrhosis, standard coagulation tests (INR, platelet count) do not accurately reflect bleeding risk due to 'rebalanced haemostasis' – both pro- and anticoagulant factors are reduced. Routine correction with FFP and platelets is NOT recommended as it delays endoscopy, causes volume overload, and does not improve outcomes. The HALT-IT trial showed tranexamic acid did not reduce mortality in GI bleeding. Fibrinogen replacement (cryoprecipitate) may be considered if <1.0 g/L.

Reference: eTG – 2025 – Gastrointestinal; Baveno VII – 2022 – Portal Hypertension Consensus