Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

Background and study aims: Upper gastrointestinal bleeding due to ruptured esophageal varicesis still remaining serious and life-threatening complication in patients with liver cirrhosis. The mortality from bleeding esophageal varicesreaches about 15-20% (Carbonell et al; 2004).There are many risk factors of bleeding from esophageal varicesincluding alcohol use, large varix size, and presence of risky signs on the varix (e.g. cherry red spots) (Jalan and Hayes, 2000). It wasdetected that increased portal vein diameter and low platelet countwere associated with presence of large esophageal varices and; as aresult, high risk of bleeding (Sudha-Rani et al; 2015).Correction of coagulopathy state in patients with liver cirrhosis isa common clinical concept especially in case of variceal bleeding. TheAmerican Association for the Study of Liver Diseases (AASLD)considered fresh frozen plasma and platelets transfusion to controlbleeding esophageal varices in patients with significant coagulopathyand/or thrombocytopenia (Garcia-Tsao et al; 2007). International normalized ratio (INR) is derived from prothrombin time(PT).It is calculated as a ratio of the patient{u2019}s PT in seconds to a control PT.The reference values for INR take into account in PT measurement in devicerelated variations and type of reagents used. INR has been initially used toreflect anticoagulation effect of warfarin (Pourafkari et al; 2019).INR elevation in chronic liver disease has been considered by cliniciansas an evidence of coagulopathy which should be corrected in case ofvariceal bleeding. However, pathophysiology of coagulopathy in cirrhoticpatients have more complexity; so that, INR may not be valid or accurate to express the coagulopathy status in these patients. Also,correction of theINR may not be beneficial in the management of bleeding esophagealvarices (Caldwell et al; 2006)

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