Parameters for Predicting Bleeding Events in Patients with Liver Disease

Although the increased bleeding risk in patients with both acute and chronic liver disease is recognized, strategies to predict the occurrence are lacking. A team from South Korea discussed parameters to do just that during a poster session 57^th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida.

“The concept that patients with liver disease are at an increased risk of bleeding, based solely on abnormalities of conventional coagulation tests such as prothrombin time (PT) international normalized ratio (INR), is now recognized to be an overly simplistic interpretation of an extremely complex situation,” the authors wrote.

Thromboelastography (TEG) is on the market as a quick point-of-care whole blood viscoelastic assay. It uses whole blood to determine the kinetics of coagulation from the initial clot formation to final clot strength, with plasmatic and cellular components. The team set out to compare TEG citrated whole blood coagulation parameters and conventional coagulation parameters.

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Using 175 patients with liver disease (with a median age of 56 and 42.7% female) and 84 healthy controls, the researchers analyzed blood samples between January and October 2015. The liver disease group were split into two — those with hepatitis (acute or chronic) and those with liver cirrhosis (with or without hepatocellular carcinoma). The parameters used in the analysis were:

• Reaction time (R): Measure of initial fibrin formation
• Constant (K): Indicative of clot formation time
• Angle (a): Indicative of the rapidity of fibrin cross-linking
• Maximal amplitude (MA): Indicative of overall clot firmness

Platelet count, hemoglobin, creatinine, total bilirubin, and prothrombin time (PT INR) were measured as well. The Model for End-Stage Liver Disease (MELD) score was used to determine liver disease severity.

In the hepatitis group (52 patients), platelet count, hemoglobin, and MA outcomes were significantly different compared to healthy controls. The liver cirrhosis group (123 patients) showed significant differences in platelet count, hemoglobin, PT INR, and all TEG parameters when compared to the control group. R, however, was the only factor that did not show statistical significance in either group.

“In this study, we suggest reference values of sodium citrated blood for kaolin-activated TEG,” the research concluded. “TEG is considered as an additional test for investigating liver disease and predicting the prognosis in this category of patients.”

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