Prospective comparison of viscoelastic coagulation monitor (VCM) and rotational thromboelastometry (ROTEM) in the assessment of cirrhosis coagulopathy.

BACKGROUND

Rotational thromboelastometry (ROTEM) provides comprehensive hemostasis assessment in cirrhosis but relies on exogenous activators, potentially limiting its reflection of in vivo conditions. The Viscoelastic Coagulation Monitor (VCM) is a new, activator-free device to assess whole-blood coagulation dynamics.

OBJECTIVES

To investigate the concordance between VCM and ROTEM and to explore their association with clinical outcomes in cirrhosis.

METHODS

We prospectively included 110 patients with cirrhosis admitted to our service. VCM and ROTEM were performed at hospitalization. All patients were followed up for bleeding, thrombosis, hepatic decompensation and liver-related mortality.

RESULTS

Patients were mostly male (68.2%) with a median age of 61 years (53-68). Alcohol-related liver disease was the most common etiology (44.5%). 16.4% of patients were Child-Pugh A, 39.1% B, and 32.7% C. Inter-test analysis showed that parameters of VCM and ROTEM had moderate to strong correlation (ρ = 0.37-0.84, p < 0.0001). We observed progressive, significant alterations of VCM in parallel with disease severity (Child-Pugh C > B > A). In contrast, ROTEM was comparable between Child-Pugh A and B patients, being altered only in Child-Pugh C cirrhosis. The median follow-up was 11 months (7-13). No patient experienced bleeding or thrombosis. Incidence of hepatic decompensation and liver-related death was 27.2% and 14.5%, respectively. No VCM parameter was associated with decompensation/death.

CONCLUSIONS

In a prospective cohort of hospitalized cirrhosis patients, VCM showed more gradual hemostatic changes across disease severity stages than ROTEM. However, neither test predicted decompensation or liver-related death, indicating that viscoelastic assessment alone is insufficient for prognosis. Further studies are needed to define VCM's role in cirrhosis management.