Bleeding in Hospitalized Patients With Liver Disease Undergoing Invasive Procedures
Bleeding in Hospitalized Patients With Liver Disease Undergoing Invasive Procedures
Patients with cirrhosis are frequently hospitalized and often undergo procedures. Knowledge
 surrounding bleeding risk is sparse and practice patterns vary across centers in regards to
 bleeding prophylaxis. The goal of this study to is to obtain more knowledge regarding risk
 factors for procedural related bleeding in patients with cirrhosis and to develop a
 predictive model to risk stratify patients before undergoing procedures. Through
 collaboration from centers across the world this study should provide information on
 prevalence of bleeding and variation in practice patterns for prophylaxis.
Hospitalized patients with cirrhosis who undergo 1 or more non-surgical procedure will be
 enrolled. The investigators will collect multiple clinical characteristics from the medical
 record and follow the patients prospectively over the hospitalization and/or until 28 days to
 determine if clinical events have occurred including bleeding, thrombosis, re-hospitalization
 and death. Characteristics of the hospitalization will be recorded including presence of
 acute decompensation and acute on chronic liver failure (ACLF). Procedure type will be
 recorded including coagulation laboratory data before and after each procedure. All bleeding
 events will be recorded and characteristics surrounding each bleed will be recorded. Bleeding
 will be defined according to International Thrombosis and Haemostasis (ISTH) definitions of
 major bleed and clinically relevant non-major bleed. REDCap (https://www.project-redcap.org)
 will be used to collect and centralize data maintained at the University of Virginia.
 Characteristics of each hospitalization will be recorded accordingly and patients will be
 followed for 28 days for outcome and mortality information. Each participating center will
 obtain local Institutional Review Board (IRB) approval to participate and enter data directly
 into REDCap. After center IRB approval is obtained, centers will consecutively enroll
 patients on a rolling basis for 4 weeks. Data will be collected from enrollment until death,
 transplant, discharge and/or 28 days on each individual enrolled.
Inclusion Criteria:

 -  Adult patients with cirrhosis admitted to a hospital ward or ICU for greater than 24
 hours.

 -  Patient must undergo 1 or more invasive non-surgical procedures at admission or during
 the hospitalization.

 Exclusion Criteria:

 -  Age < 18 years old

 -  Prisoner

 -  Pregnant

 -  Unable to provide consent

 -  Previously enrolled in this study