Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver Injury/Failure
| Autor: | Daniel Ganger, Jody C. Olson, R. Todd Stravitz, Iris Liou, Robert J. Fontana, Brendan M. McGuire, Ton Lisman, Jody Rule, Bilal Hamid, Kristin Clasen, Michael W. Cripps, David G. Koch, Constantine J. Karvellas, Valerie Durkalski-Mauldin, Adrian Reuben, William M. Lee, Michael L. Schilsky, Caitlyn Meinzer, A. James Hanje |
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| Přispěvatelé: | Groningen Institute for Organ Transplantation (GIOT) |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Hemorrhage Liver transplantation Severity of Illness Index Fibrin Young Adult Internal medicine medicine Coagulopathy Humans Renal replacement therapy Hepatic encephalopathy Acetaminophen Aged Hepatology biology business.industry Blood Coagulation Disorders Liver Failure Acute Middle Aged medicine.disease Thrombelastography Thromboelastometry Hemostasis Cardiology biology.protein Female Chemical and Drug Induced Liver Injury business medicine.drug |
| Zdroj: | Hepatology, 74(2), 937-949. Wiley |
| ISSN: | 1527-3350 0270-9139 |
| Popis: | Background and Aims: Patients with acute liver injury or failure (ALI/ALF) experience bleeding complications uncommonly despite an abnormal hemostatic profile. Rotational thromboelastometry (ROTEM), which assesses clot formation in whole blood, was used to determine the nature of abnormal hemostasis and whether it contributes to bleeding events, illness severity, or survival.Approach and Results: A total of 200 patients were recruited from sites of the ALF Study Group. Blood collected daily for up to 5 days was analyzed using ROTEM delta devices. Consistent with standard laboratory evidence of hypocoagulability (median international normalized ratio = 2.9 and platelet count = 144 × 109/L), patients frequently exhibited ROTEM parameters outside the normal range (73% and 62% had abnormalities in clot formation from extrinsic and intrinsic clotting cascades, respectively); however, measures of clot stability were generally normal. Eighteen patients (9%) experienced bleeding events, in whom clot initiation, assembly, and firmness were more severely deranged than patients without bleeding. Abnormal ROTEM parameters were more frequently observed in patients with non-acetaminophen ALI/ALF than those with acetaminophen ALI/ALF (clot initiation [P Conclusions: In patients with ALI/ALF, abnormal ROTEM parameters are frequent and proportional to disease severity. Whether the increased bleeding risk associated with abnormal ROTEM indicates hemostatic failure or is a proxy for disease severity requires additional study. |
| Databáze: | OpenAIRE |
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