Thromboelastography Parameters in Patients with Acute on Chronic Liver Failure

Area of Science:

• Hepatology
• Coagulation Science
• Point-of-Care Testing

Background:

• Patients with acute on chronic liver failure (ACLF) often present with abnormal conventional coagulation tests, including platelet count and international normalized ratio (INR).
• Thromboelastography (TEG) offers a more comprehensive assessment of hemostasis than conventional tests, evaluating platelet function, coagulation factors, and clot retraction.

Purpose of the Study:

• To evaluate and compare thromboelastography (TEG) parameters in patients with ACLF, those with acute decompensation (AD) of chronic liver disease, and healthy controls (HC).

Main Methods:

• TEG parameters were assessed within 24 hours of admission for 179 participants (68 ACLF, 53 AD, 58 HC) over a 12-month period.
• Conventional coagulation tests (platelet count, INR) and TEG variables were analyzed and compared across the three groups.

Main Results:

• While INR was significantly higher in ACLF and AD groups compared to HC (P < 0.001), most TEG parameters, including r time, k time, and alpha angle, were normal in over 90% of patients and did not differ significantly between groups.
• A reduced maximum amplitude (MA) was observed in ACLF and AD patients compared to HC (P < 0.001).
• Lysis at 30 minutes (LY30) was elevated in ACLF patients compared to AD and HC (P = 0.060), though TEG parameters did not vary across different ACLF grades.

Conclusions:

• Despite abnormal conventional coagulation tests, thromboelastography (TEG) parameters in ACLF patients are largely normal, with the exception of reduced maximum amplitude.
• The findings suggest that TEG may have limited utility in assessing the overall coagulation status in ACLF patients based on current parameters.
• Further research is warranted to explore the potential role and specific applications of TEG in the clinical management of ACLF.