Rotational thromboelastometry can detect factor <scp>XIII</scp> deficiency and bleeding diathesis in patients with cirrhosis

Bedreli, Sotiria; Sowa, Jan-Peter; Malek, Saraa; Blomeyer, S.; Katsounas, Antonios; Gerken, Guido; Saner, Fuat H.; Canbay, Ali

doi:10.1111/liv.13254

Cited by 43 publications

(34 citation statements)

References 30 publications

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“…In a retrospective study of 74 cirrhotic patients, reduced maximum clot formation on ROTEM has shown to detect factor XIII deficiency, which the current conventional coagulation tests are unable to measure. Low factor XIII levels were also associated with significantly higher mortality and bleeding complications . In another pilot study, thromboelastogram was able to predict accurately bleeding risk following central venous cannulation in patients with cirrhosis .…”

Section: Discussionmentioning

confidence: 99%

Suboptimal use of pharmacological venous thromboembolism prophylaxis in cirrhotic patients

Yang

Alukaidey

Croucher

et al. 2018

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Suboptimal use of pharmacological venous thromboembolism prophylaxis in cirrhotic patients

Yang

Alukaidey

Croucher

et al. 2018

Internal Medicine Journal

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“…Viscoelastic tests have (whole blood) clot formation as the endpoint, which is an obvious advantage to thrombin generation tests or routine diagnostic tests such as the PT, which have thrombin generation or the time point of fibrinogen to fibrin conversion in plasma as the endpoint. In addition, viscoelastic tests are sensitive for the activity of coagulation factor XIII . However, an obvious limitation of viscoelastic tests in patients with complex disorders of hemostasis is that it is not a true representation of hemostatic balance as it lacks activation of the anticoagulant protein C system, and is insensitive for von Willebrand factor.…”

Section: Rebalanced Hemostasis In Liver Diseasesmentioning

confidence: 99%

Pathogenesis, prevention, and management of bleeding and thrombosis in patients with liver diseases

Lisman

Porte

2017

Research and Practice in Thrombosis and Haemostasis

111

129

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Essentials Patients with liver diseases may acquire substantial changes in all components of hemostasis.Hemostasis is in unstable balance due to simultaneous changes in pro‐ and antihemostatic systems.Intrahepatic activation of hemostasis may contribute to disease progression.Optimal strategies for prevention and treatment of bleeding and thrombosis are currently unknown. Patients with liver diseases may develop alterations in all components of the hemostatic system. Thrombocytopenia, low levels of coagulation factors and inhibitors, low levels of fibrinolytic proteins, and increased levels of endothelial‐derived proteins such as von Willebrand factor are all part of the coagulopathy of liver disease. Due to concomitant changes in pro‐ and antihemostatic drivers, the net effects of these complex hemostatic changes have long been unclear. According to current concepts, the hemostatic system of patients with liver disease is in an unstable balance, which explains the occurrence of both bleeding and thrombotic complications. This review will discuss etiology and management of bleeding and thrombosis in liver disease and will outline unsolved clinical questions. In addition, we will discuss the role of intrahepatic activation of coagulation for progression of liver disease, a novel paradigm with potential consequences for the general management of patients with liver disease.

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“…1 A simultaneous decline in pro-and anticoagulant drivers results in a "rebalanced" haemostatic system. [2][3][4] External factors may tip the balance towards hypo-or hypercoagulability, 5 and distinct hypo- [6][7][8][9][10] and hypercoagulable [11][12][13][14] features in patients with liver disease which may predispose them to bleeding or thrombotic complications.…”

Section: Introductionmentioning

confidence: 99%

In vitro efficacy of pro‐ and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

Lisman

Kleiss

Patel

et al. 2018

Liver International

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Background & AimsA simultaneous decline in pro‐ and anticoagulant drivers in patients with liver diseases results in a “rebalanced” haemostatic system, even in acutely ill patients. Nevertheless, both bleeding and thrombotic events are common. Here, we explored efficacy of pro‐ and antihaemostatic strategies in compensated and acutely ill cirrhotics which may be unpredictable given the profound haemostatic changes.MethodsWe tested the effects in vitro of the addition of clinically relevant doses of commonly used pro‐ and antihaemostatic strategies in plasma from healthy individuals (n = 30) and patients with compensated (n = 18) and acutely decompensated cirrhosis (n = 18), and acute‐on‐chronic liver failure (n = 10). We used thrombin generation tests and fibrin clot permeability assays to assess potency of various approaches.ResultsFresh frozen plasma and recombinant factor VIIa modestly increased thrombin generation (10%‐20%). Prothrombin complex concentrate increased thrombin generation two‐fold in controls and 2‐4‐fold in patients. Clot permeability decreased after addition of fibrinogen concentrate by 51% in controls and by 50%‐60% in patients. Low molecular weight heparin decreased thrombin generation by 18% in controls and by 23%‐54% in patients. Similarly, dabigatran decreased thrombin generation by 33% in controls and by 47%‐100% in patients. In contrast, rivaroxaban decreased thrombin generation by 55% in controls, but only by 11%‐38% in patients.ConclusionsThese in vitro data suggest little prohaemostatic effect of fresh frozen plasma and recombinant factor VIIa in acutely ill cirrhotics, whereas prothrombin complex concentrate and fibrinogen concentrate clearly improved haemostasis. Furthermore, our data suggest the requirement for dose adjustments of commonly used anticoagulants in these patients.

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Rotational thromboelastometry can detect factor XIII deficiency and bleeding diathesis in patients with cirrhosis

Cited by 43 publications

References 30 publications

Suboptimal use of pharmacological venous thromboembolism prophylaxis in cirrhotic patients

Suboptimal use of pharmacological venous thromboembolism prophylaxis in cirrhotic patients

Pathogenesis, prevention, and management of bleeding and thrombosis in patients with liver diseases

In vitro efficacy of pro‐ and anticoagulant strategies in compensated and acutely ill patients with cirrhosis

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