A 50 year old patient with HIV, HCV cirrhosis presents to the emergency room with subjective fevers and generalized abdominal pain with tenderness. As part of your workup, you plan for a diagnostic paracentesis. On ultrasound imaging, the patient has a large amount of easily tapped ascites. His INR, however, returns at 2.9. Should you proceed with your procedure?

Answer: Yes. If you suspect SBP (spontaneous bacterial peritonitis), your patient deserves a prompt diagnostic paracentesis. Coagulopathy isĀ common in patients with cirrhosis and is not an absolute contraindication.

Multiple studies support this perspective:

  • A retrospective study of 608 patients showed no increased bleeding in patients with mild to moderate coagulopathy (defined as plts 50-99 or PT twice “normal”).
  • In a study of 1,100 LVPs, in which the INR ranged from 0.9-8.7 (interquartile range, 1.4-2.2), there were no significant post-procedure complications.
  • A chart review of 4,729 paracentesis procedures revealed only nine episodes of severe hemorrhage, but found no correlation between these episodes and elevated INR, thrombocytopenia, or operator experience.


  1. McVay PA, Toy PT. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion. 1991 Feb;31(2):164-71.
  2. Grabau CM, Crago SF, Hoff LK, Simon JA, Melton CA, Ott BJ, Kamath PS. Performance standards for therapeutic abdominal paracentesis. Hepatology. 2004 Aug;40(2):484-8.
  3. Pache I, Bilodeau M. Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease. Aliment Pharmacol Ther. 2005 Mar 1;21(5):525-9.