Transfusion and Haemostasis
Background and Goal of Study: The cirrhotic patients were assumed to have a bleeding tendency based on standard coagulation tests. Recent studies showed a state of rebalanced hemostasis in which abnormalities in procoagulant factors are compensated by changes in anticoagulant drivers.Since standard tests of coagulation only asses components of clot formation those tests cannot reflect this rebalanced state of the cirrhotic coagulopathy.
Rotation thromboelastometry ROTEM is a point-of-care device that enables evaluation of the process of clot initiation, formation and stability using whole blood.
The goal of the study was to asses the correlation between standard coagulation laboratory tests (SCT) and ROTEM parameters in cirrhotic patients, and also to investigate if the ROTEM parameters reflect the severity of the liver disease.
Materials and methods: 26 pretransplant patients with liver cirrhosis were included in a retrospective observational study. Standard coagulation tests-INR/PT, aPTT, platelet number, fibrinogen levels and rotation thrombelastometry (ROTEM) were performed. Patients that received recently fresh frozen plasma, cryoprecipitate, platelet concentrate or coagulation factors were excluded from the study group. MELD, MELD Na scores and the intraoperative bleeding were recorded.Statistical analysis was performed using SPSS Statistics v.19.1.
Results and discussion: The study group included 20 men (77.%) and 6 women. Mean (±SD) age was 52.15 (±10.08) years. CT and CFT of INTEM correlated well with aPTT (p=0.046 and 0.024 respectively). CT of EXTEM showed a good correlation with INR ( p=0.012), but CFT of EXTEM did not correlate with INR (p=0.262). Clot amplitude at 10 minutes (A10) of EXTEM and INTEM and maximum clot firmness (MCF) of both EXTEM and INTEM correlated well with fibrinogen levels and platelet number. MCF of FIBTEM showed a very good correlation with fibrinogen levels (p< 0.01). None of the ROTEM parameters studied correlated with the severity of the liver disease as assessed by MELD and MELD-Na scores. The quantity of blood loss during liver transplantation did not correlate with any of thepreoperative ROTEM parameters.
Conclusion(s): In our study we found good correlations between SCT and ROTEM parameters, except for CFT (EXTEM) and INR. The patients in the study group showed normal or hypocoagulability on SCT and none of the patients was detected with hypercoagulability on the ROTEM parameters.