Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver...

Area of Science:

• Hepatology
• Hematology
• Critical Care Medicine

Background:

• Patients with acute liver injury or failure (ALI/ALF) often present with abnormal hemostasis but uncommonly experience bleeding complications.
• Rotational thromboelastometry (ROTEM) is a whole blood assay that assesses clot formation and dynamics.

Purpose of the Study:

• To investigate the nature of hemostatic abnormalities in ALI/ALF patients using ROTEM.
• To determine if ROTEM parameters correlate with bleeding events, illness severity, or survival outcomes.

Main Methods:

• 200 ALI/ALF patients were enrolled, with daily ROTEM analysis for up to 5 days.
• ROTEM parameters were compared between patients with and without bleeding, different ALI/ALF etiologies, disease severity, and survival outcomes.

Main Results:

• 73% and 62% of patients showed abnormalities in extrinsic and intrinsic clotting pathways, respectively, despite generally normal clot stability.
• Abnormal ROTEM parameters were more prevalent in non-acetaminophen ALI/ALF, severe systemic complications (hepatic encephalopathy, renal replacement therapy), and in non-survivors or those undergoing transplantation.
• Patients experiencing bleeding events had more deranged clot initiation, assembly, and firmness compared to those without bleeding.

Conclusions:

• Abnormal ROTEM parameters are common in ALI/ALF and correlate with increased disease severity.
• The clinical significance of ROTEM-detected hemostatic dysfunction in ALI/ALF requires further investigation to differentiate between hemostatic failure and a marker of severe illness.