Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver Injury/Failure

Stravitz, R. Todd; Fontana, Robert J.; Meinzer, Caitlyn; Durkalski‐Mauldin, Valerie; Hanje, A. James; Olson, Jody C.; Koch, David; Hamid, Bilal; Schilsky, Michael L.; McGuire, Brendan M.; Ganger, Daniel; Liou, Iris; Karvellas, Constantine J.; Rule, Jody; Lisman, Ton; Clasen, Kristin; Reuben, Adrian; Cripps, Michael W.; Lee, William M.

doi:10.1002/hep.31767

Cited by 32 publications

(38 citation statements)

References 29 publications

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“…By contrast, 90% of patients who had a clear hypocoagulable trace at ROTEM ® (all 4 parameters reflecting clot formation and stability below normal range) did not experience bleeding, which suggests that ROTEM ® cannot be used to identify patients with ACLF at higher risk of bleeding. This is in line with recent findings from a multicentre, prospective cohort study including 200 patients with acute liver injury and acute liver failure 40 . In fact, despite multiple and significant alterations of ROTEM ® all indicative of a severe hypocoagulable state, Stravitz et al 40 found no correlation between alterations of ROTEM ® , performed at admission and occurrence of bleeding complications during hospitalization.…”

Section: Discussionsupporting

confidence: 78%

“…This is in line with recent findings from a multicentre, prospective cohort study including 200 patients with acute liver injury and acute liver failure. 40 In fact, despite multiple and significant alterations of ROTEM ® all indicative of a severe hypocoagulable state, Stravitz et al 40 found no correlation between alterations of ROTEM ® , performed at admission and occurrence of bleeding complications during hospitalization.…”

Section: Discussionmentioning

confidence: 98%

“…Yet, we intentionally did not exclude such factors to evaluate coagulation in a real‐life cohort of patients with ACLF. Third, while we studied coagulation in sample taken at hospital admission or at time of ACLF diagnosis, it is well known that AD and particularly ACLF are dynamic conditions in which a longitudinal assessment may perhaps be more informative, especially regarding prediction of bleeding 14,15,40 . Finally, although we carefully excluded bleeding events unrelated to haemostatic failure, the correlation between alterations of coagulation and bleeding was limited by the relatively low number of outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Third, while we studied coagulation in sample taken at hospital admission or at time of ACLF diagnosis, it is well known that AD and particularly ACLF are dynamic conditions in which a longitudinal assessment may perhaps be more informative, especially regarding prediction of bleeding. 14 , 15 , 40 Finally, although we carefully excluded bleeding events unrelated to haemostatic failure, the correlation between alterations of coagulation and bleeding was limited by the relatively low number of outcomes. Therefore, further studies with larger sample size and a longitudinal design are required to truly assess whether ROTEM ® is not useful to predict occurrence of bleeding in hospitalized patients with AD and ACLF.…”

Section: Discussionmentioning

confidence: 99%

“…ACLF had longer INR (1.9 [1.5-2.5] vs 1.6 [1.3-1.9]; P = .007) and aPTT (44 seconds[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] vs 35 seconds[30][31][32][33][34][35][36][37][38][39][40][41][42]; P < .001) compared with patients with AD.…”

mentioning

confidence: 99%

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Coagulopathy is not predictive of bleeding in patients with acute decompensation of cirrhosis and acute‐on‐chronic liver failure

Campello

Zanetto

Bulato

et al. 2021

Liver International

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Background & Aims Understanding factors responsible for the increased bleeding tendency in acute‐on‐chronic liver failure (ACLF) would improve the management of these complications. We investigated coagulation alterations in ACLF and assessed whether they were predictive of bleeding. Methods Cirrhosis patients with ACLF (cases) and acute decompensation (AD, controls) were prospectively recruited and underwent an extensive haemostatic assessment including standard tests, pro and anticoagulant factors, thrombomodulin‐modified thrombin generation (TG) and thromboelastometry (ROTEM®). In study part 1 (case‐control), we compared coagulation in ACLF vs AD. In study part 2 (prospective), all patients were followed for bleeding, and predictors of outcome were assessed. Results Ninety‐one patients were included (51 with ACLF, 40 with AD). Infections and ascites/renal dysfunction were the most common precipitating and decompensating events. Platelet count was lower while INR and activated partial thrombin time were longer in ACLF cohort vs AD. Regarding clotting factors, fibrinogen and factor VIII were comparable between groups while protein C and antithrombin were significantly reduced in ACLF. Endogenous thrombin potential by TG was comparable between groups. Clotting formation time and clot stability by ROTEM® were significantly lower in ACLF, indicative of a more hypocoagulable state. No haemostasis alteration could discriminate between patients who had bleeding complications during hospitalization and those who did not. Conclusion We found coagulation changes in ACLF to largely overlap with that of AD and evidence of preserved coagulation capacity in both groups. ROTEM alterations were indicative of a more pronounced hypocoagulable state in ACLF; however, no correlation was found between such alterations and bleeding.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Coagulopathy is not predictive of bleeding in patients with acute decompensation of cirrhosis and acute‐on‐chronic liver failure

Campello

Zanetto

Bulato

et al. 2021

Liver International

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Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Smith

Barlow

et al. 2023

J Am Coll Clin Pharm

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non‐trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.

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Coagulopathy and hemostasis management in patients undergoing liver transplantation

Pillai

Kriss

Al‐Adra

et al. 2022

Liver Transplantation

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Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies Anjana A. Pillai and Michael Kriss contributed equally to this study and share co-first authorship.Constantine J. Karvellas and Nicolas Intagliata contributed equally to this study and share co-senior authorship.

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Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver Injury/Failure

Cited by 32 publications

References 29 publications

Coagulopathy is not predictive of bleeding in patients with acute decompensation of cirrhosis and acute‐on‐chronic liver failure

Coagulopathy is not predictive of bleeding in patients with acute decompensation of cirrhosis and acute‐on‐chronic liver failure

Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Coagulopathy and hemostasis management in patients undergoing liver transplantation

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