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Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Thromboelastographic Evaluation of Coagulation in Patients With Liver Disease
Kyung Hwa Shin1, In Suk Kim2, Hyun Ji Lee3
1Department of Laboratory Medicine, Pusan National University School of Medicine and Biomedical Research Institute Research Institute, Pusan National University Hospital, Busan, Korea.
Insights
Thromboelastography (TEG) can identify coagulopathy in chronic liver disease (CLD) patients, but its parameters do not predict disease severity or transfusion needs. Abnormal TEG results were more frequent in cirrhotic patients.
Area of Science:
- Hepatology
- Hematology
- Clinical Diagnostics
Background:
- Chronic liver disease (CLD) is associated with coagulopathy.
- Evaluating coagulopathy in CLD patients is crucial for clinical management.
- Thromboelastography (TEG) is a viscoelastic assay used to assess blood clot formation and lysis.
Purpose of the Study:
- To investigate thromboelastography (TEG) parameters for evaluating coagulopathy in patients with chronic liver disease (CLD).
- To determine the association between TEG parameters and disease severity (Child-Pugh and MELD scores).
- To assess the correlation of TEG parameters with transfusion requirements in CLD patients.
Main Methods:
- Adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), plus 84 healthy controls, were enrolled.
- TEG parameters (R, K, α, MA, CI) were measured using kaolin-activated citrated blood.
- Standard laboratory tests (platelet count, PT INR, albumin, bilirubin, creatinine) and CLD severity scores were assessed.
Main Results:
- Significant differences in TEG parameters, PT INR, and platelet count were observed in the cirrhotic group compared to others.
- Abnormal TEG parameters were found in 17.3% of non-cirrhotic and 44.7% of cirrhotic patients, indicating hypocoagulability.
- TEG parameters showed a weak correlation with PT INR and could not predict CLD severity or transfusion requirements.
Conclusions:
- TEG measurements can be informative for assessing coagulopathy in CLD patients.
- TEG may aid in investigating coagulopathy and predicting bleeding risk.
- Further research is needed to fully establish the clinical utility of TEG in CLD management.
Background:
The aims of this study were to investigate the parameters of thromboelastography (TEG) for evaluating coagulopathy and to reveal an association with disease severity and/or transfusion requirement in patients with chronic liver disease (CLD) in a clinical laboratory setting.
Methods:
We enrolled two groups of adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), as well as 84 healthy controls. Reaction time (R), kinetic time (K), α-angle (α), maximal amplitude (MA), and coagulation index (CI) were measured with kaolin-activated citrated blood with the TEG 5000 system (Haemonetics Corporation, USA). Platelet count, prothrombin time international normalized ratio (PT INR), albumin, bilirubin, and creatinine were simultaneously measured. The CLD severity was calculated by using the Child-Pugh (C-P) and Model for End-stage Liver Disease (MELD) scores. Transfusion history was also reviewed.
Results:
All TEG parameters, PT INR, and platelet count in the cirrhotic group showed significant differences from those in other groups. At least one or more abnormal TEG parameters were identified in 17.3% and 44.7% of patients in the non-cirrhotic and cirrhotic group, respectively. Patients with cirrhotic disease had hypocoagulability. A weak correlation between R and PT INR (r=0.173) was noted. The TEG parameters could not predict CLD severity using the C-P and MELD scores. Patients with normal TEG parameters did not receive transfusion.
Conclusions:
Clinical application of TEG measurements in CLD can be informative for investigating coagulopathy or predicting the risk of bleeding. Further studies are warranted.
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