Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients

Tomescu, Dana; Popescu, Mihai; Vitin, Alexander A.

doi:10.2478/jccm-2018-0012

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…In our study, the levels of FIBTEM-MCF were within normal range and similar between the groups, though the amount of bleeding and transfusion use were much higher in the HCA group. It indicates that fibrinogen is not precisely predicting intraoperative bleeding or transfusion use [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

Ise

Kuwabara

Oyama

et al. 2020

Gen Thorac Cardiovasc Surg

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Objectives Hypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM). Methods We retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group. Results Operation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference. Conclusion Our study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

Ise

Kuwabara

Oyama

et al. 2020

Gen Thorac Cardiovasc Surg

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A surface-functionalized whole blood-based dielectric microsensor for assessment of clot firmness in a fibrinolytic environment

Pourang,

Disharoon,

Hernandez

et al. 2025

Biosensors and Bioelectronics

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The coagulation changes associated with acute variceal bleeding in patients with HCV-induced cirrhosis as assessed by rotational thromboelastometry

El-Makarem,

Mohammad,

Afifi

et al. 2024

Egypt Liver Journal

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Background and objectives Alterations of hemostasis in patients with decompensated cirrhosis are complex. Accordingly, standard coagulation tests are not feasible to evaluate bleeding risk in these patients. The aim of this study was to assess the coagulation kinetics in cirrhotic patients with variceal bleeding using rotational thromboelastometry (ROTEM). ROTEM including EXTEM, INTEM, and FIBTEM which represent extrinsic, intrinsic pathways, and fibrinogen activity, respectively, was measured in 60 cirrhotic patients with variceal bleeding who were compared to 60 patients with stable cirrhosis. APTEM was optionally performed to evaluate fibrinolysis. Results Overall, cirrhosis patients displayed features of hypofibrinolysis, whereas the state of hypocoagulability was significantly higher in cirrhotic patients with variceal bleeding (61.7% versus 30%, p = 0.001). Values of clot formation time (CFT) by EXTEM and INTEM correlated positively with those of model for end-stage liver disease score (r = 0.529, p = 0.001, and r = 0.595, p < 0.001, respectively). Furthermore, in a multivariate analysis, values of CFT in both assays were significantly associated with increased risk of 1.9 (95% CI = 1.04–2.45, p = 0.02) and of 1.78 (95% CI = 1.02–2.14, p = 0.01), respectively, for occurrence of variceal bleeding. Conclusion Cirrhotic patients with variceal bleeding frequently showed a hypocoagulable state that is triggered by thrombocytopenia and/or hypofibrinogenemia. CFT by EXTEM and INTEM seemed to be an extra marker for disease severity and prognosis in cirrhosis patients, in addition to its valuable role in prediction of variceal bleeding in these patients. However, large multicenter studies have yet been required.

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Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients

Cited by 3 publications

References 15 publications

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

A surface-functionalized whole blood-based dielectric microsensor for assessment of clot firmness in a fibrinolytic environment

The coagulation changes associated with acute variceal bleeding in patients with HCV-induced cirrhosis as assessed by rotational thromboelastometry

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