Vox sanguinis · 2025
Viscoelastic haemostatic assays in chronic liver disease-Profiling coagulation in the emergency department.
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Latona Akmez, Hill Kate, Roberts Lara, Stuart Katherine, Winearls James, Mitra Biswadev
Аннотация
BACKGROUND AND OBJECTIVES: The role of viscoelastic haemostatic assays (VHAs) versus conventional coagulation tests (CCTs) in chronic liver disease (CLD) in the emergency department (ED) is undefined. We aimed to characterize VHA profiles and concordance with CCT.
MATERIALS AND METHODS: Patients with CLD presenting to EDs (January 2016-August 2023) were included. Post-transfusion results were excluded. VHA was categorized as hypo/normo/hypercoagulable using manufacturer ranges. CCT-coagulopathy was defined as international normalized ratio (INR) >1.5, platelets <50 × 109/L or fibrinogen <1.0 g/L.
RESULTS: VHA use increased over time (incidence rate ratio [IRR] 1.23, 95% confidence interval [CI]: 1.19-1.28; p < 0.001). Of 438 patients, 397 underwent rotational thromboelastometry (ROTEM) and 41 thromboelastography (TEG). ROTEM showed hypocoagulability in 275 patients (69%), normocoagulability in 84 (21%), hypercoagulability in 18 (5%) and mixed profiles in 14 (4%). Deficits were fibrinogen deficiency in 220 patients (55%), factor deficiency in 148 (37%), hyperfibrinolysis in 42 (11%) and platelet deficiency in 33 (8%). TEG showed hypocoagulability in 22 (54%), normocoagulability in 13 (32%), hypercoagulability in 3 (7%) and mixed profiles in 3 (7%). Deficits included fibrinogen deficiency in 19 patients (46%), factor deficiency in 6 (15%), hyperfibrinolysis in 5 (12%) and platelet deficiency in 3 (7%). In 120 VHA-CCT paired results, fibrinogen deficiency was detected by both in 18%, VHA alone 26%, CCT alone 2%; platelet deficiency by both 5%, VHA alone 5%, CCT alone 5%; factor deficiency by both 22%, VHA alone 3% and CCT alone 42%.
CONCLUSION: Hypocoagulability from reduced fibrin-based clot strength was predominant. Marked discordance between VHA and CCT was observed in coagulation factor deficiency. CLD-specific thresholds are required to guide transfusion.
MATERIALS AND METHODS: Patients with CLD presenting to EDs (January 2016-August 2023) were included. Post-transfusion results were excluded. VHA was categorized as hypo/normo/hypercoagulable using manufacturer ranges. CCT-coagulopathy was defined as international normalized ratio (INR) >1.5, platelets <50 × 109/L or fibrinogen <1.0 g/L.
RESULTS: VHA use increased over time (incidence rate ratio [IRR] 1.23, 95% confidence interval [CI]: 1.19-1.28; p < 0.001). Of 438 patients, 397 underwent rotational thromboelastometry (ROTEM) and 41 thromboelastography (TEG). ROTEM showed hypocoagulability in 275 patients (69%), normocoagulability in 84 (21%), hypercoagulability in 18 (5%) and mixed profiles in 14 (4%). Deficits were fibrinogen deficiency in 220 patients (55%), factor deficiency in 148 (37%), hyperfibrinolysis in 42 (11%) and platelet deficiency in 33 (8%). TEG showed hypocoagulability in 22 (54%), normocoagulability in 13 (32%), hypercoagulability in 3 (7%) and mixed profiles in 3 (7%). Deficits included fibrinogen deficiency in 19 patients (46%), factor deficiency in 6 (15%), hyperfibrinolysis in 5 (12%) and platelet deficiency in 3 (7%). In 120 VHA-CCT paired results, fibrinogen deficiency was detected by both in 18%, VHA alone 26%, CCT alone 2%; platelet deficiency by both 5%, VHA alone 5%, CCT alone 5%; factor deficiency by both 22%, VHA alone 3% and CCT alone 42%.
CONCLUSION: Hypocoagulability from reduced fibrin-based clot strength was predominant. Marked discordance between VHA and CCT was observed in coagulation factor deficiency. CLD-specific thresholds are required to guide transfusion.