Paracentesis and Coagulopathies

Author: Dr. Ethan Szpara

Edited by: Kevin Cao 

Clinical Question

Diagnostic paracentesis is a common procedure that takes place in the Emergency Department.  I found that while working at UIC I noted an increased prevalence of coagulopathies in patients with liver disease

I questioned how this might affect our approach to procedures being performed on these patient’s such as diagnostic paracentesis.  One of our chief’s recommended that I look at this study to address this question. 

Article of Interest

Rowley M.W, Agarwal S, Seetharam A, Hirsch K.S. Real-Time Ultrasound-Guided paracentesis by Radiologists: Near Zero Risk of Hemorrhage without Correction of Coagulopathy. Journal of Vascular and Interventional Radiology. 2019; 30, 2: 259-264

Study Design

This was a retrospective study that included all patients from a large liver transplant center that underwent diagnostic and therapeutic paracentesis over a two-year period. Patient data was obtained through an extensive review of this institutions EMR. The purpose was to evaluate the rate of hemorrhage in patient undergoing real-time, US guided paracentesis without any correction of coagulopathy.


Patients that received paracentesis without correction of coagulopathy had a bleeding risk of 0.19%. In total 6 patients of the 3,116 patients required post-paracentesis pRBC transfusion. No patients died from paracentesis related complications. 




Pache I, Bilodeau M. Severe hemorrhage following abdominal para-centesis for ascites in patients with liver failure. Aliment Pharmacol Ther 2005; 21:525–529.

Northup P.G, Caldwell S.H. Coagulation in Liver Disease: A Guide for the Clinician.  Clinical Gastroenterology and Hepatology. 2013;11, 9: 1064-1074.  

Giannini E.G, Greco A, Marenco S, Andorno E, Valente U, Savarino V. Clinical Gastroenterology and Hepatology, 2010; 8,10. 899-902.