News Release

AGA recommends change in testing protocol for cirrhosis patients

The American Gastroenterological Association (AGA) issues formal guidelines on the management of coagulation disorders in cirrhosis patients.

Peer-Reviewed Publication

American Gastroenterological Association

Bethesda, MD (November 3, 2021) — Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. The American Gastroenterological Association (AGA) has released new clinical guidelines to change how physicians identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

“Patients with cirrhosis typically have abnormal markers of coagulation, which in the past were interpreted as indicating a higher risk of bleeding,” says lead author Dr. Robert S. O’Shea of the Cleveland Clinic Main Campus in Cleveland, Ohio. “However, this has not been borne out in clinical practice, and accumulating evidence suggests that the use of these tests is inappropriate. Despite this, because of the concerns related to these tests of blood clotting, the care of these patients has been compromised - requiring frequent and often unnecessary testing or transfusion prior to undergoing routine procedures important in their treatment. This has essentially exposed them to risk with no benefit.”

Key guideline recommendations:

  1. Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio (PT/INR) or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
  2. Blood products, including fresh frozen plasma (FFP) or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
  3. Standard pharmacologic venous thromboembolism (VTE) prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
  4. Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis (PVT) in patients with cirrhosis to improve patient outcomes.

Cirrhosis is permanent injury or damage to the liver by chronic diseases, such as viral hepatitis (b or c), nonalcoholic fatty liver disease, hemochromatosis or long-term alcohol abuse. Learn more in the AGA GI Patient Center.

Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.



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Media contact: Courtney Reed,, 301-272-0025

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.

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About Gastroenterology

Gastroenterology is the most prominent journal in the field of gastrointestinal disease. As the official journal of the AGA InstituteGastroenterology delivers up-to-date and authoritative coverage of both basic and clinical gastroenterology. Regular features include articles by leading authorities and reports on the latest treatments for diseases. Original research is organized by clinical and basic-translational content, as well as by alimentary tract, liver, pancreas, and biliary content.


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