Hematological abnormalities in liver cirrhosis

Table 1 Comparison between the definitions of the values reported in thromboelastography and rotational thromboelastometry[34,120]

Section	Parameter	Definition and function
Clot initiation	ROTEM: CT	Measures from test start until fibrin begins to be formed (clot reaches a 2 mm diameter) and reflects time to fibrin formation. Low clotting factors and/or low fibrinogen level, vitamin K antagonists, heparin and DOAC use prolong this measurement. Recommended therapy: Fresh frozen plasma/prothrombin complex concentrate may be considered
	TEG: RT
Clot kinetics or fibrin polymerization	ROTEM: CFT	Reflects the speed at which fibrin is formed and how well it binds to platelets. It is the time it takes until the clot reaches 20 mm (arbitrary size). α angle is defined as the slope between section 1 and 2 and is a measure of the rapidity of fibrin polymerization. This parameter is dependent on sufficient fibrinogen, fibrin cross-linking and platelet number and function
	TEG: KT
	Both: Α angle
Clot strength or stiffness	ROTEM: MCF	It is the maximum clot diameter in millimeters and is a combined assessment of fibrinogen and platelet interactions. To differentiate their effects, the standard trace should be compared with the fibrinogen trace. For the clinician, this is the most useful parameter since it represents both primary and secondary hemostasis. Recommended therapy: Platelets (if normal fibrinogen assay), cryoprecipitate or fibrinogen concentrate (if low fibrinogen assay)
	TEG: MA
Clot breakdown or fibrinolysis	ROTEM: CL-30	As platelet retraction is a normal phenomenon, some clot strength diminution is expected. It is usually presented as a percentage reduction in the clot strength measure compared to maximal measurement at a given time (30 minutes after CT). Recommended therapy: Consider anti-fibrinolytic agent or reperfusion (if liver transplantation surgery)
	TEG: LY30

CT: Clotting time; RT: Reaction time; ROTEM: Rotational thromboelastometry; CFT: Clot formation time; TEG: Thromboelastography; KT: Kinetics time; MCF: Maximum clot formation; MA: Maximum amplitude; CL-30: Clot lysis at 30 minutes; LY30: Lysis at 30 minutes; PCC: Prothrombin complex concentrate; DOAC: Direct oral anticoagulant.