TY - JOUR
T1 - Coagulation in acutely ill patients with severe chronic liver disease
T2 - Insights from thromboelastography
AU - Lloyd-Donald, Patryck
AU - Vasudevan, Abhinav
AU - Angus, Peter
AU - Gow, Paul
AU - Mårtensson, Johan
AU - Glassford, Neil
AU - Eastwood, Glenn M.
AU - Hart, Graeme K
AU - Bellomo, Rinaldo
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background and aims There is controversy about the true coagulation state of acutely ill patients with chronic liver disease (CLD) due to simultaneous pro- and anticoagulant factor deficits and limitations of conventional coagulation tests (CCTs). Thromboelastography (TEG) may provide more physiologically relevant insights. Methods In acutely ill patients with severe (Child-Pugh C) CLD, we conducted a prospective observational study of daily coagulation assessment with both CCTs and TEG. Results We studied 34 patients with CLD on a total of 109 occasions (median of 3 samples per patient), comparing findings with 157 healthy controls. Conventional coagulation tests and TEG both demonstrated clear hypocoagulability. Thromboelastography-confirmed delayed clot formation was demonstrated by longer reaction time (1.1 minutes vs 0.6 minutes on rapid TEG; P < .01), longer kinetic time (2.9 minutes vs 1.3; P < .01), more acute α angle (65° vs 72.2° P < .01), and longer activated clotting time (157 seconds vs 105 seconds; P < .01). Patients with CLD demonstrated weaker thrombus strength (maximum amplitude, 43.3 mm vs 61.8 mm; P < .01) and reduced clot lysis (0% vs 1% on rapid TEG; P < .01). Conclusions In acutely ill patients with CLD, TEG demonstrates delayed clot formation and weaker thrombus strength despite decreased clot lysis. This challenges the notion that such patients experience a balanced coagulation state, highlighting the complexity of their coagulopathies.
AB - Background and aims There is controversy about the true coagulation state of acutely ill patients with chronic liver disease (CLD) due to simultaneous pro- and anticoagulant factor deficits and limitations of conventional coagulation tests (CCTs). Thromboelastography (TEG) may provide more physiologically relevant insights. Methods In acutely ill patients with severe (Child-Pugh C) CLD, we conducted a prospective observational study of daily coagulation assessment with both CCTs and TEG. Results We studied 34 patients with CLD on a total of 109 occasions (median of 3 samples per patient), comparing findings with 157 healthy controls. Conventional coagulation tests and TEG both demonstrated clear hypocoagulability. Thromboelastography-confirmed delayed clot formation was demonstrated by longer reaction time (1.1 minutes vs 0.6 minutes on rapid TEG; P < .01), longer kinetic time (2.9 minutes vs 1.3; P < .01), more acute α angle (65° vs 72.2° P < .01), and longer activated clotting time (157 seconds vs 105 seconds; P < .01). Patients with CLD demonstrated weaker thrombus strength (maximum amplitude, 43.3 mm vs 61.8 mm; P < .01) and reduced clot lysis (0% vs 1% on rapid TEG; P < .01). Conclusions In acutely ill patients with CLD, TEG demonstrates delayed clot formation and weaker thrombus strength despite decreased clot lysis. This challenges the notion that such patients experience a balanced coagulation state, highlighting the complexity of their coagulopathies.
KW - Coagulopathy
KW - Global coagulation assays
KW - Hepatic cirrhosis
KW - Thromboelastography
UR - https://www.scopus.com/pages/publications/85013677141
U2 - 10.1016/j.jcrc.2016.10.030
DO - 10.1016/j.jcrc.2016.10.030
M3 - Article
AN - SCOPUS:85013677141
SN - 0883-9441
VL - 38
SP - 215
EP - 224
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -