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Title: Coagulation in acutely ill patients with severe chronic liver disease: insights from thromboelastography
Austin Authors: Lloyd-Donald, Patryck ;Vasudevan, Abhinav ;Angus, Peter W ;Gow, Paul J ;Mårtensson, Johan;Glassford, Neil J;Eastwood, Glenn M ;Hart, Graeme K ;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna, Sweden
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Issue Date: Apr-2017 2016-11-04
Publication information: Journal of Critical Care 2017; 38: 215-224
Abstract: Background and aims There is controversy about the true coagulation state of acutely ill patients with chronic liver disease (CLD) due to simultaneous pro- and anticoagulant factor deficits and limitations of conventional coagulation tests (CCTs). Thromboelastography (TEG) may provide more physiologically relevant insights. Methods In acutely ill patients with severe (Child-Pugh C) CLD, we conducted a prospective observational study of daily coagulation assessment with both CCTs and TEG. Results We studied 34 patients with CLD on a total of 109 occasions (median of 3 samples per patient), comparing findings with 157 healthy controls. Conventional coagulation tests and TEG both demonstrated clear hypocoagulability. Thromboelastography-confirmed delayed clot formation was demonstrated by longer reaction time (1.1 minutes vs 0.6 minutes on rapid TEG; P < .01), longer kinetic time (2.9 minutes vs 1.3; P < .01), more acute α angle (65° vs 72.2°; P < .01), and longer activated clotting time (157 seconds vs 105 seconds; P < .01). Patients with CLD demonstrated weaker thrombus strength (maximum amplitude, 43.3 mm vs 61.8 mm; P < .01) and reduced clot lysis (0% vs 1% on rapid TEG; P < .01). Conclusions In acutely ill patients with CLD, TEG demonstrates delayed clot formation and weaker thrombus strength despite decreased clot lysis. This challenges the notion that such patients experience a balanced coagulation state, highlighting the complexity of their coagulopathies.
DOI: 10.1016/j.jcrc.2016.10.030
ORCID: 0000-0002-1650-8939
PubMed URL:
Type: Journal Article
Subjects: Hepatic cirrhosis
Global coagulation assays
Appears in Collections:Journal articles

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