Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 28, 2017; 9(6): 318-325
Published online Feb 28, 2017. doi: 10.4254/wjh.v9.i6.318
Thrombocytopenia in cirrhosis: Impact of fibrinogen on bleeding risk
Sonali V Thakrar, Susan V Mallett
Sonali V Thakrar, Susan V Mallett, Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free London, London NW3 2QG, United Kingdom
Author contributions: Thakrar SV and Mallett SV contributed equally to this work in designed and coordinated the research and writing the manuscript.
Institutional review board statement: This work was reviewed and approved by the Royal Free London Research and Development department and was deemed not to require ethics approval.
Informed consent statement: All data retrieved from our transplant database was anonymised. The data has been previously collected (prior to the study commencing), and was collected as part of standard care. Only those persons involved in clinical care had access to our database. No patient interventions were performed as part of this study. As a result, it was deemed unnecessary to require patient consent.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at s.thakrar1@nhs.net. Participant onsent was not obtained but the presented data are anonymised and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sonali V Thakrar, MBBS, BSc (Hons), MRCP, FRCA, Clinical Research Fellow, Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free London, Pond Street, London NW3 2QG, United Kingdom. s.thakrar1@nhs.net
Telephone: +44-207-77940500
Received: July 27, 2016
Peer-review started: July 29, 2016
First decision: September 28, 2016
Revised: December 23, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: February 28, 2017
Core Tip

Core tip: Current literature describing bleeding risk in thrombocytopenia and cirrhosis does not take into account the impact of fibrinogen. The minimal platelet count to form a clot with normal strength is unknown, and would be influenced by fibrinogen. Viscoelastic testing, particularly maximum amplitude (MA, thromboelastography) or maximum-clot-firmness (MCF, thromboelastometry), reflects platelet-fibrinogen interaction and allows assessment of clot strength. Low platelet count and low fibrinogen levels lead to low MA/MCF and correlate strongly with increased bleeding tendency. Assessment of platelet count alone does not accurately predict bleeding, but is useful in conjunction with other indices such as clauss fibrinogen and MA/MCF.