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Updated: May 21, 2026

Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Evaluation of coagulation abnormalities in acute liver failure
Banwari Agarwal1, Gavin Wright, Alex Gatt
1Department of Intensive Care Medicine, Royal Free Hospital, London, United Kingdom.
In acute liver failure (ALF), elevated prothrombin time (PT) does not accurately predict bleeding risk. Coagulation is complex and requires individualized assessment for ALF patients.
Area of Science:
- Hematology
- Hepatology
- Clinical Coagulation
Background:
- Acute liver failure (ALF) presents with elevated prothrombin time (PT) and prothrombin time ratio (PTR), often used as bleeding risk indicators.
- The clinical utility of PT/PTR in reflecting actual hemostatic potential and bleeding risk in ALF remains unclear.
Purpose of the Study:
- To investigate whether elevated PT/PTR in ALF patients accurately reflects their hemostatic potential and bleeding risk.
- To characterize the complex coagulation abnormalities in ALF.
Main Methods:
- Analysis of 20 consecutive ALF patients using standard clotting tests, thromboelastography (TEG), procoagulant and anticoagulant factors, thrombin generation (TG) assays, and microparticle assays.
- Comparison of TG kinetics with 20 healthy volunteers.
Main Results:
- Elevated PT (50.7s ± 7.2) did not correlate with TEG parameters, showing diverse coagulation states (hypocoagulable, normal, hypercoagulable).
- ALF patients exhibited reduced procoagulants and natural anticoagulants, alongside elevated Factor VIII and Von Willebrand factor, maintaining efficient thrombin generation.
- No significant bleeding complications or transfusions were observed despite deranged PT.
Conclusions:
- Coagulation disturbances in ALF are complex and heterogeneous, not solely predicted by PT/PTR.
- An individualized approach is necessary for assessing bleeding risk in ALF patients.
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