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Coagulopathy in Cirrhosis Endoscopy — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyCoagulopathy in Cirrhosis EndoscopyRACP Adult Medicine

A 68-year-old man with cirrhosis and oesophageal varices requires screening endoscopy. His platelet count is 38 × 10⁹/L and INR is 1.9. Should platelet transfusion or FFP be administered before endoscopy?

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Correct answer: C — Postpone endoscopy until coagulopathy resolves spontaneously

In cirrhosis, standard coagulation tests (INR, platelet count) do NOT accurately reflect bleeding risk due to 'rebalanced haemostasis' – both pro-coagulant AND anticoagulant factors are reduced proportionally. Routine correction of INR/platelets before diagnostic endoscopy is NOT recommended (Baveno VII, AASLD). FFP causes volume overload without proven benefit. Platelet transfusion may be considered for invasive procedures (biopsy, polypectomy) in patients with very low platelets (<30 × 10⁹/L) but is not required for diagnostic endoscopy. Thromboelastography (TEG/ROTEM) provides a more accurate assessment of coagulation status in cirrhosis.

Reference: Baveno VII – 2022; eTG – 2025 – Gastrointestinal