Impact of thrombocytopenia and coagulopathy on partial hepatectomy and Hassab's operation in patients with cirrhosis: a multicenter retrospective cohort study.

Background: Thrombocytopenia (TCP) and coagulation disorders are common complications for patients with liver cirrhosis. The impact of severe TCP [30 × 10/L < platelets (PLT) ≤ 50 × 10/L] and coagulation disorder on bleeding risk after Hassab's operation or partial hepatectomy (PH) for cirrhotic patients is unclear.

Method: Our study retrospectively enrolled 724 cirrhotic patients from July 2019 to August 2024, including 189 patients who underwent Hassab's operation and 535 patients with hepatocellular carcinoma who underwent PH without prophylactic platelet transfusions or thrombopoietin receptor agonists. Patients were categorized into severe TCP (30 × 10/L < PLT ≤ 50 × 10/L) and mild/moderate TCP (50 × 10/L < PLT ≤ 150 × 10/L) groups, and INR < 1.5 and INR ≥ 1.5 groups, respectively. The 6-week postoperative bleeding rate was recorded.

Results: Severe TCP or INR ≥ 1.5 has no significant effect on increased 6-week postoperative bleeding rate for patients with cirrhosis who not only underwent Hassab's operation ( > 0.05), but also underwent PH ( > 0.05). Besides, elevated Child-Pugh score was linked with increased postoperative bleeding of Hassab's operation (HR = 2.932, 95%CI 1.796-4.786,  < 0.001) and PH (HR = 2.140, 95%CI 1.588-2.883,  < 0.001), and creatinine (HR = 1.029, 95%CI 1.011-1.048,  = 0.002) and surgical procedure (HR = 0.388, 95%CI 0.163-0.919,  = 0.031 was another risk factor associated with postoperative bleeding rate for patients who underwent Hassab's operation and PH separately.

Conclusion: Both TCP and INR have no significant impact on increased bleeding rate after Hassab's operation or PH for patients with cirrhosis. Child-Pugh score is a risk factor for 6-week bleeding after Hassab's operation or PH. Additionally, creatinine is another risk factor associated with high 6-week postoperative bleeding of Hassab's operation, and laparoscopy is a protective factor associated with 6-week postoperative bleeding of PH.