Safety of invasive procedures in patients with the coagulopathy of liver disease.

To assess the need for prophylactic fresh frozen plasma in patients with chronic liver disease before procedures, we followed 39 consecutive patients with prothrombin times (PT) of 15-29 s who had 71 invasive procedures. A total of 57 procedures was done in 30 patients receiving no blood product support, while 12 patients received blood products within 12 h of 14 procedures. Only three of the latter group received fresh frozen plasma prophylactically to improve the PT. The two groups were similar in the severity of their liver disease. There were nine surgical procedures as well as paracenteses, thoracenteses, lumbar punctures, and central venous line placement. Three bleeding episodes occurred. Two of the bleeding episodes required no further treatment. Because of the low incidence of bleeding and the ease in controlling the bleeding once it occurred, fresh frozen plasma is not recommended for prophylaxis of an elevated prothrombin time.