Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.2097
Peer-review started: February 11, 2020
First decision: February 27, 2020
Revised: March 26, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: May 7, 2020
Processing time: 86 Days and 1 Hours
Liver cirrhosis leads to hemostatic alterations. Despite laboratory findings suggesting a coagulopathy, these do not reflect bleeding events in cirrhosis patients. Routine diagnostic tests display relevant limitations, as they may not provide accurate information on the hemostatic status; they cannot predict bleeding risk and may therefore not provide clinically relevant information.
Viscoelastic tests are global tests of coagulation, which assess the viscoelastic properties of blood. The aim of the present study was to assess the haemostatic profile of patients suffering from mild to advanced liver cirrhosis, including platelet function testing and viscoelastic testing. Results originating from these tests may close the gap in testing patients with liver cirrhosis for
The objective was to study the hemostatic profile of patients with liver cirrhosis and to correlate results from both tests with the severity of liver cirrhosis.
Platelet function was measured by multiple electrode aggregometry using the multiplate analyzer 15 min after blood draw and after activation with commercially available standard reagents. Blood samples were analyzed at 37 °C. Thrombelastometric assays were performed 15 min after blood draw. Blood samples were analyzed at 37 °C using ROTEM delta analyzer. A runtime of 60 min was applied and regular quality control tests and ROTEM tests were run in accordance with the manufacturer’s instructions. Data comparisons of patient characteristics and results of multiple electrode aggregometry (MEA) and thrombelastometry were made using Mann-Whitney U- or Fisher’s exact-test, where applicable. To correlate parameters from MEA and thrombelastometry with other parameters, Spearman rank correlation analysis fitting a linear regression line were performed.
Our prospective study in 50 patients with suffering from mild to advanced liver cirrhosis showed that the hemostatic profile assessed by viscoelastic tests is not associated with the severity of liver cirrhosis according to model for end-stage liver disease (MELD) score and ranged from normal to hypocoagulable state. In detail, comparing the observed MEA results to severity of liver cirrhosis, those patients who displayed abnormal results below the reference range showed mostly mild thrombopenia especially in the group of advanced liver cirrhosis.
Our data demonstrate a partially impaired hemostatic profile of both platelet function and plasmatic coagulation in cirrhotic patients, but no correlation of impairment with the severity of liver cirrhosis. Therefore, the hemostatic potential or a hemostatic therapy should not be judged by MELD score alone but rather by an individual and patient-specific assessment. Further, our data indicate that a potential coagulopathy in advanced liver cirrhosis may not be reflected by thrombelastometry or multiple electrode aggregometry as the underlying mechanisms may be beyond the platelet function of hemostasis. In clinical practice, viscoelastic testing may prove to be an asset in the assessment of hemostatic profiling of patients suffering from liver cirrhosis.
Ultimately, further tests need to be developed to further reflect/identify patients with an impaired hemostatic potential.