Ann Lab Med.  2017 May;37(3):204-212. 10.3343/alm.2017.37.3.204.

Thromboelastographic Evaluation of Coagulation in Patients With Liver Disease

• Shin KH
• Kim IS
• Lee HJ
• Kim HH
• Chang CL
• Hong YM
• Yoon KT
• Cho M

• KMID: 2369745
• DOI: http://doi.org/10.3343/alm.2017.37.3.204

Abstract

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.

Keyword

Thromboelastography; Coagulation; Transfusion; Liver disease

MeSH Terms

Adult
Bilirubin
Creatinine
Hemorrhage
Humans
International Normalized Ratio
Liver Diseases*
Liver*
Platelet Count
Prothrombin Time
Reaction Time
Thrombelastography
Bilirubin
Creatinine

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