Paracentesis in Patients with Ascites and Ongoing Coagulopathy

Safety Profile with Coagulopathy

Paracentesis can be performed safely in patients with ascites regardless of coagulopathy status, including those on continuous therapeutic anticoagulation, as recommended by the American Gastroenterological Association and the European Association for the Study of the Liver 1, 2
The procedure is remarkably safe even with severe coagulopathy, with bleeding complications occurring in less than 1 in 1,000 procedures, according to the American College of Gastroenterology 1

Clinically evident hyperfibrinolysis with three-dimensional ecchymosis or hematoma formation is a contraindication to paracentesis, as stated by the American College of Gastroenterology 3
Clinically evident disseminated intravascular coagulation is also a contraindication, according to the European Association for the Study of the Liver 3

For large-volume paracentesis (>5 L), albumin administration is mandatory, with 8 g albumin per liter of ascites removed, as recommended by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver 1, 2
In patients with acute-on-chronic liver failure (ACLF), 6-8 g/L of albumin should be administered regardless of volume removed, according to the American College of Gastroenterology 1