Association of thromboelastography profile with severity of liver cirrhosis and portal venous system thrombosis

Abstract Background and aim Hemostasis profile is often complicated in liver cirrhosis. Thromboelastography is a global viscoelastic test recommended by the current practice guideline and consensus. This cross-sectional study aimed to evaluate the association of thromboelastography profile with severity of liver cirrhosis and presence of portal venous system thrombosis (PVST). Methods Overall, 116 and 50 cirrhotic patients were included in the Shenyang and Xi’an cohorts, respectively. Thromboelastography parameters were compared between cirrhotic patients with Child–Pugh class A and B/C, those with and without decompensated events, and those with and without PVST. Hypercoagulability would be considered if at least two of the following thromboelastography parameters were met: shortened reactive time (R), shortened coagulation time (K), increased angle, and increased maximum amplitude (MA). Results In the Shenyang cohort, 16 patients had shortened R, of whom seven (43.75%) had prolonged K and 11 (68.75%) decreased MA. In the Xi’an cohort, 24 patients had shortened R, of whom seven (29.17%) had prolonged K and 15 (62.50%) decreased MA. In the Shenyang cohort, the prevalence of hypercoagulability was not significantly different between cirrhotic patients with Child–Pugh class A and B/C (3.85% vs. 6.25%, P = 0.873), those with and without decompensated events (5.49% vs. 4.00%, P = 1.000), and those with and without PVST (4.17% vs. 5.88%, P = 1.000), which were similar to the results obtained in the Xi’an cohort. Conclusion There is a high rate of discordance between R and other thromboelastography parameters. In addition, hypercoagulability may not be related to more advanced stage of liver cirrhosis or presence of PVST.

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Correlation of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24879 ◽

2018 ◽

Vol 16 (2) ◽

pp. 50-53

Author(s):

Anil Shrestha ◽

Dipendra Khadka ◽

Richa Shrestha

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

Cross Sectional ◽

Class A ◽

Red Color ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Small Varices

Background: Majority of cirrhotic patients develop varices over their lifetime and it is anticipated that roughly one third of varices will develop bleeding. Child Turcotte Pugh (CTP) class predicts the risk of variceal bleeding and has been used as a prognostic tool inpatients of liver cirrhosis. Objective: To correlate grade of esophageal varices in Upper Gastrointestinal endoscopy with Child Turcotte Pugh class in patients of liver cirrhosis. Material and method: This is a cross sectional descriptive study conducted in thedepartment of medicine of NGMCTH, Kohalpur between December 2017 to November 2018. A total of 97 patients were included inthe study who were diagnosed as cirrhosis of liver clinically and radio logically. Patient were classified into CTP class A, B and According to CTP score. UGI endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP classand the data were recorded and analysed. Result: Mean of patients was 50 years. Among 97 patients, 30 (30.9%) were in CTP class A,30 (30.9%) in CTP class B and 37 (38.1%) were in CTP class C. 25 (25.8%) had small varices, 50 (51.5%) had large varices with red colorsign, 20 (20.6%) had large varices without red color sign and 2 (2.1%) had no varices. Most of the patients in CTP class B and C hadlarge varices with red color sign whereas CTP class A had small varices. Conclusion: The cirrhotic patients in CTP class B and C havelarge varices with red color sign and have more chances of bleeding. Hence, routine screening is indicated to determine the presenceof varices. Porphylactic therapy after identifying large varices will decrease the incidence of bleeding leading to reduction inmortality rate.

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No Association of Homocysteine, Anticardiolipin Antibody, and Anti-β2 Glycoprotein I Antibody With Portal Venous System Thrombosis in Liver Cirrhosis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211010969 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110109

Author(s):

Le Wang ◽

Xiaozhong Guo ◽

Xiangbo Xu ◽

Shixue Xu ◽

Juqiang Han ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Vein ◽

Anticardiolipin Antibody ◽

Venous System ◽

Common Complication ◽

Portal Venous System ◽

Main Portal Vein ◽

Glycoprotein I ◽

Cirrhotic Patients ◽

Clinically Significant

Portal venous system thrombosis (PVST), a common complication of liver cirrhosis, is closely associated with thrombophilia. To explore the association of homocysteine (Hcy), anticardiolipin antibody (aCL), and anti-β2 glycoprotein I antibody (aβ2GPI), which are possible thrombophilic factors, with PVST in liver cirrhosis. Overall, 654 non-malignant patients (219 with and 435 without liver cirrhosis) admitted between January 2016 and June 2020 were retrospectively evaluated. Presence of PVST, degree of main portal vein (MPV) thrombosis, and clinically significant PVST were identified. Hcy level, hyperhomocysteinemia (HHcy), aCL positivity, and aβ2GPI positivity were compared according to the presence of liver cirrhosis and PVST. Positive aβ2GPI was significantly more frequent in patients with liver cirrhosis than those without, but Hcy level and proportions of HHcy and positive aCL were not significantly different between them. PVST could be evaluated in 136 cirrhotic patients. Hcy level [10.57 μmol/L (2.71-56.82) versus 9.97 μmol/L (2.05-53.44); P = 0.796] and proportions of HHcy [4/44 (9.1%) versus 13/81 (16.0%); P = 0.413] and positive aCL [1/23 (4.3%) versus 10/52 (19.2%); P = 0.185] and aβ2GPI [9/23 (39.1%) versus 21/52 (40.4%); P = 0.919] were not significantly different between cirrhotic patients with and without PVST. There was still no significant association of Hcy level, HHcy, aCL, or aβ2GPI with PVST based on Child-Pugh classification, MPV thrombosis >50%, and clinically significant PVST. Hcy, aCL, and aβ2GPI may not be associated with PVST in liver cirrhosis, suggesting that routine screening for Hcy, aCL, and aβ2GPI should be unnecessary in such patients.

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The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

BMC Gastroenterology ◽

10.1186/s12876-019-1123-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Daniel W. Gunda ◽

Semvua B. Kilonzo ◽

Zakhia Mamballah ◽

Paulina M. Manyiri ◽

David C. Majinge ◽

...

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Clinical Laboratory ◽

Cross Sectional Study ◽

Endoscopic Examination ◽

Clinical Predictors ◽

Endoscopic Screening ◽

Cross Sectional ◽

Northwestern Tanzania ◽

Cirrhotic Patients

Abstract Background Bleeding esophageal varices is a deadly complication of liver cirrhosis. Guidelines recommend an early diagnosis of esophageal varices before incident bleeding by screening all patients diagnosed with liver cirrhosis. Though it has been reported elsewhere that the presence of esophageal varices varies widely among cirrhotic patients this has not been assessed in Tanzania since endoscopy is not readily available for routine use in our setting. This study was designed to determine the prevalence of esophageal varices and assess the utility of clinical parameters in predicting the presence of varices among cirrhotic patients in northwestern Tanzania. Methods A cross-sectional analysis of adult patients with liver cirrhosis was done at Bugando Medical Centre. Demographic, clinical, laboratory and endoscopic data were collected and analyzed using STATA 13. The presence of esophageal varices was detected using endoscopic examination and associated factors were assessed by logistic regression. The predictive value of clinical predictors was also assessed by calculating sensitivity and specificity. Results A total of 223 patients were enrolled, where 88 (39.5%; 95%CI: 33.0–45.9) had esophageal varices. The varices were independently associated with increased age (OR: 1.02; 95%CI: 1.0–1.04; p = 0.030); increased splenic diameter (OR:1.3; 95%CI:1.2–1.5; p < 0.001), increased portal vein diameter (OR:1.2; 95%CI: 1.07–1.4; p = 0.003), having ascites (OR: 3.0; 95%CI: 1.01–8.7; p = 0.046), and advanced liver disease (OR: 2.9; 95%CI: 1.3–6.7; p = 0.008). PSDR least performed in predicting varices, (AUC: 0.382; 95%CI: 0.304–0.459; cutoff: < 640; Sensitivity: 58.0%; 95%CI: 46.9–68.4; specificity: 57.0%; 95%CI: 48.2–65.5). SPD had better prediction; (AUC: 0.713; 95%CI: 0.646–0.781; cut off: > 15.2 cm; sensitivity: 65.9%; (95% CI: 55–75.7 and specificity:65.2%; 95%CI: 56.5–73.2), followed by PVD, (AUC: 0.6392; 95%CI: 0.566–0.712;cutoff: > 1.45 cm; sensitivity: 62.5%; 95CI: 51.5–72.6; specificity: 61.5%; 95%CI: 52.7–69.7). Conclusion Esophageal varices were prevalent among cirrhotic patients, most of which were at risk of bleeding. The non-invasive prediction of varices was not strong enough to replace endoscopic diagnosis. However, the predictors in this study can potentially assist in the selection of patients at high risk of having varices and prioritize them for endoscopic screening and appropriate management.

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Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

Journal of Medicine ◽

10.3329/jom.v22i2.56698 ◽

2021 ◽

Vol 22 (2) ◽

pp. 100-106

Author(s):

Tarana Yasmin ◽

Sohely Sultana ◽

Mahmuda Nusrat Ima ◽

Md Quamrul Islam ◽

Shyamal Kumar Roy ◽

...

Keyword(s):

Liver Cirrhosis ◽

Doppler Ultrasound ◽

Hepatic Vein ◽

Wave Form ◽

Venous Blood Flow ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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HEPATIC ENCEPHALOPATHY

The Professional Medical Journal ◽

10.29309/tpmj/18.4679 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1857-1862

Author(s):

Ashok Kumar Lohano ◽

Shamsuddin Shaikh ◽

Nazia Arain

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Serum Sodium Level ◽

Cross Sectional Study ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Cross Sectional ◽

Medicine Department ◽

Grade Ii ◽

Cirrhotic Patients

Objectives: To determine the prevalence and relation to severity of hyponatremia in liver cirrhotic patients associated with hepatic encephalopathy. Study Design: Cross sectional study. Place and Duration of Study: Medicine Department of Peoples University of Medical and Health Sciences Nawabshah from 26th October 2016 to 25th April 2017. Material and Methods: All patients of either gender with 15 to 70 years associated liver cirrhosis, were included in the study. Diagnosis of liver cirrhosis was confirmed by laboratory and ultrasonographic findings. Exclusion criteria were patients outside of patient range, patients with hepatocellular carcinoma, or anotherco morbid. Sodium levels were measured by 2cc bloodsample by blood from cubital vein preferably. Encephalopathy was evaluated via West Haven classification. All the data were entered into SPSS 20 version and were analyzed by using the same software. Results: A total of 369 patients met the inclusion criteria. Among them were 129 males and 240 females. The overall mean age of study subjects was 57.07±9.23 years. The overall mean duration of hepatic encephalopathy was 2.53±0.733 days. The overall mean serum sodium level for study subjects was 129.59±7.11 mEq/L. Most of the study subjects, 83.5% had HCV, 12.7% patients were HBV positive whereas 3% were positive for HBV as well as HCV. 26 patients had grade 1 encephalopathy, 30 patients had grade II encephalopathies, 258 patients had grade III encephalopathies, and 55 patients had grade IV encephalopathy. In our study, 73.2% study subjects were observed with hyponatremia. Out of 270 study subjects found with hyponatremia, 25.2% had mild hyponatremia, 44.8% had moderate hyponatremia, and 30% had severe hyponatremia. The results showed that there was a significant association of hyponatremia with viral markers (p=0.030), duration of hepatic encephalopathy (p=0.102) and grades of hepatic encephalopathy (p=0.746). Conclusion: We concluded hyponatremia is frequently found in patients with cirrhosis liver. Significant correlation of hyponatremia with the severity of hepatic encephalopathy.

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Association between serum irisin concentrations and sarcopenia in patients with liver cirrhosis: a cross-sectional study

Scientific Reports ◽

10.1038/s41598-020-73176-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Mingyuan Zhao ◽

Xiaoshuang Zhou ◽

Chengying Yuan ◽

Rongshan Li ◽

Yuehong Ma ◽

...

Keyword(s):

Liver Cirrhosis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lumbar Vertebra ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Skeletal Muscle Index ◽

Multivariable Regression ◽

Cirrhotic Patients

Abstract Sarcopenia is an independent predictor of mortality in patients with liver cirrhosis. However, evidence has emerged that skeletal muscles mediate their protective effect against sarcopenia by secreting myokines. Therefore, we investigated whether irisin was associated with sarcopenia in patients with liver cirrhosis. This was an observational cross-sectional study of data collected from 187 cirrhotic patients. Sarcopenia was defined by computed tomography (CT) scans using specific cutoffs of the 3rd lumbar vertebra skeletal muscle index (L3 SMI). Morning irisin levels were obtained in all patients. Of the 187 patients, sarcopenia was noted in 73 (39%). Irisin concentrations were lower in sarcopenic patients (32.40 pg/ml [interquartile range (IQR): 18.70, 121.26], p < 0.001) than in nonsarcopenic patients. There was a weak correlation between L3 SMI and irisin levels (r = 0.516, p < 0.001). Multivariable regression analysis including L3 SMI, body mass index (BMI), very-low-density lipoprotein (VLDL)-cholesterol, aspartate aminotransferase (AST), adiponectin, and irisin levels showed that L3 SMI (odds ratio [OR] = 0.915, p = 0.023), adiponectin levels (OR = 1.074, p = 0.014), irisin levels (OR = 0.993, p < 0.001) and BMI (OR = 0.456, p = 0.004) were independently associated with sarcopenia. Irisin levels are associated with sarcopenia in patients with liver cirrhosis. This paper addresses a gap in the literature and facilitates the future transition into clinical treatment.

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Correlation of global longitudinal strain with disease severity in liver cirrhosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.155 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Dimitroglou ◽

C Aggeli ◽

A Alexopoulou ◽

T Alexopoulos ◽

D Patsourakos ◽

...

Keyword(s):

Liver Cirrhosis ◽

Disease Severity ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Class A ◽

Class B ◽

Pugh Class ◽

Cirrhotic Patients ◽

Class C

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/purpose Cirrhotic cardiomyopathy is characterized by high cardiac output, reduced peripheral resistance and diastolic dysfunction and has been correlated with cirrhosis severity and prognosis. Global longitudinal strain (GLS) is a sensitive marker of cardiac dysfunction which is considered relatively independent of preload and afterload conditions and thus may be of high diagnostic significance in this special population. We sought to investigate alterations of GLS relating to disease severity in cirrhotic patients. Methods Echocardiographic analysis of 51 consecutive cirrhotic patients was performed. Images were acquired and analyzed off-line. GLS was calculated with a semi-automatic way using dedicated software. Clinical and biochemical examination were used to assess severity of liver disease by calculating Child-Pugh class (class C patients have more severe disease than class B and A patients) and MELD-Na score (increased score as the disease progresses). Results Mean age was 58.4 ± 8.7 years, 38 (74.5%) were males. Among patients, 22 (43.1%) were Child-Pugh class A, 17 (33.3%) Child-Pugh B and 12 (23.5%) Child-Pugh C and mean MELD-Na score was 15.3 ± 7.5. Mean left ventricular end-systolic volume (LVEDV) was 117 ± 29ml, mean stroke volume (SV) 72.5 ± 19.9ml , mean left ventricular ejection fraction (LVEF) 61.0 ± 5.0%, mean systolic blood pressure (SBP) 128 ± 13mmHg, mean ratio of peak transmitral to peak annular (septal) velocity during early diastole (E/e’ ratio) 10.4 ± 4.5, mean left atrial volume index (LAVI) 37.4 ± 11.8 ml/cm2 and mean GLS -21.6 ± 2.6%. GLS of Child-Pugh class A patients (-20.3 ± 2.4) was higher (less negative) than GLS of Child-Pugh class B (-22.2 ± 2.2) and class C (-23.0 ± 2.8) patients. Difference between groups B and C was non-significant (figure). Severity of cirrhosis as determined by higher MELD-Na score correlated with LAVI (r = 0.592, p < 0.001), SV (r = 0.554, p < 0.001), GLS (r=-0.441, p = 0.001) and LVEDV (r = 0.428, p = 0.002). GLS correlated with SV (r=-0.369, p = 0.008) but not with preload (LVEDV), or afterload (SBP). In a linear regression model, GLS was independently associated with Meld-Na score when adjusting for age, SBP, LVEDV and NASH etiology [B=-0.139 (-0.252; -0.025), p = 0.018]. Conclusions GLS is lower (more negative) in patients with liver cirrhosis as disease progresses a relation not affected by preload and afterload conditions. Further research works are required to explain the underlying pathophysiology and to assess prognostic significance of reduced GLS values in patients with advanced cirrhosis. Abstract Figure. GLS stratified by Child-Pugh score

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Prevalence of hyponetremia in cirrhotic patients with encephalopathy.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.09.4676 ◽

2021 ◽

Vol 28 (09) ◽

pp. 1308-1314

Author(s):

Tauqeer Shaikh ◽

Hamid Ali Kalwar ◽

Ghulam Mujtaba ◽

Adeel Rahat ◽

Kamaran Ali ◽

...

Keyword(s):

Liver Cirrhosis ◽

Neurological Impairment ◽

Cross Sectional Study ◽

Common Finding ◽

National Hospital ◽

Cross Sectional ◽

Early Management ◽

Ethical Approval ◽

Cirrhotic Patients ◽

Study Setting

Objective: To Determine the frequency of hyponatremia in cirrhotic patients with encephalopathy. Study Design: Cross Sectional Study. Setting: Department of Gastroenterology Liaquat National Hospital Karachi. Period: 6 Dec 2017 to 6 June 2018. Material & Methods: All those fulfilling the inclusion criteria and admitted in the Gastroenterology department of Liaquat National Hospital Karachi were taken in the study after their ethical approval alongside an informed and written consent. Brief history was taken, clinical examination was done, and serum sodium level was delivered to the institutional laboratory to reach the outcome i-e hyponatremia. Results: - A number of 369 patients having encephalopathy were taken into study. 207 patients (56.1%) were males and 162 patients (43.9%) were females with an average age of 50.03+10.333 years. Hyponatremia was seen in 138 patients (37.4%). Conclusion: Dilutional hyponatremia is a common finding in liver cirrhosis patients with encephalopathy leading to neurological impairment, hepatorenal syndrome, osteoporosis and high mortality. Therefore, early management of hyponatremia is key to prevent liver cirrhosis related complications.

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Occurrence of Thrombocytopenia in Non-Cirrhotic Hepatitis C Positive Patients

Abasyn Journal Life Sciences ◽

10.34091/ajls.1.2.3 ◽

2018 ◽

pp. 77-81

Keyword(s):

Liver Cirrhosis ◽

Hepatitis C ◽

Cross Sectional Study ◽

Severe Thrombocytopenia ◽

Chronic Infections ◽

Cross Sectional ◽

Hcv Antibody ◽

Cirrhotic Patients ◽

Chronic Hcv Infection ◽

Chronic Hcv

Thrombocytopenia is commonly encountered hematological abnormality, which might be attributed to hepatitis C virus (HCV) in acute and chronic infection. This study aims to determine the prevalence of thrombocytopenia as a clinical manifestation of chronic HCV infection in non-cirrhotic patients having spleen of normal size. A cross sectional study was carried out in Ayub Teaching Hospital, Abbottabad, Khyber Pakhtunkhwa, Pakistan in Gastroenterology and Medical Outpatient Department from January to October 2017. The investigation was carried out on patients between age 20 to 60 years with anti-HCV antibody positive. All patients having liver cirrhosis, or fibrosis and splenomegaly, or having thrombocytopenia from other causes i.e. any drug use or other chronic infections were excluded from the study. A total of 67 patients fulfilling the criteria were selected. Thrombocytopenia was observed in 34.3% of the subjects, among them 17.9% exhibited mild thrombocytopenia (150000/μL to 400000/μL); 11.9% (51000/μL to 100000/μL) exhibited moderate thrombocytopenia while 4.5% (less than 50000/μL) showed severe thrombocytopenia. Thus, the study exhibited the presence of thrombocytopenia in chronic HCV patients without liver cirrhosis and splenomegaly that proves the contribution of HCV to induce thrombocytopenia. Keywords: Thrombocytopenia, HCV, Cirrhosis

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HEMOSTATIC POTENTIAL ASSESSMENT OF PATIENTS WITH LIVER CIRRHOSIS AND ATRIAL FIBRILLATION BY LOW-FREQUENCY PIEZOELECTRIC THROMBOELASTOGRAPHY

Wiadomości Lekarskie ◽

10.36740/wlek202103203 ◽

2021 ◽

Vol 74 (3) ◽

pp. 578-583

Author(s):

Alina E. Baylo ◽

Tetiana O. Maksymets ◽

Vadym P. Shypulіn ◽

Volodymyr V. Chernyavskyi ◽

Luiza M. Parunian

Keyword(s):

Atrial Fibrillation ◽

Liver Cirrhosis ◽

Anticoagulant Activity ◽

Low Frequency ◽

Maximum Amplitude ◽

Cross Sectional Study ◽

Clot Retraction ◽

Cross Sectional ◽

Coagulation Abnormalities ◽

Coagulation Assay

The aim: Our aim was to assess the hemostatic potential of patients with liver cirrhosis and atrial fibrillation by LPTEG global coagulation assay, to investigate changes in LPTEG parameters according to the stage of liver cirrhosis and compare results with liver cirrhosis group. Materials and methods: We performed a prospective cross-sectional study including 70 patients with liver cirrhosis and atrial fibrillation, 36 patients with liver cirrhosis and 20 healthy individuals. LPTEG parameters were measured using ARP-01M “Mednord” in order to assess coagulation abnormalities. Results: t1 and Intensity of contact coagulation didn't differ (p>0,05), Constant of thrombin activity was increased (47.53±0.8vs.34.51±1.88, p<0.001), t3 was reduced (5,0±0.1vs.6.7±0.36 p<0.001), Intensity of coagulation drive was increased (52.8±1.8vs.38.55±1.54, p = 0.001), Intensity of clot polymerization was increased (19.66±0.28vs.16.29±0.28, p<0.001), time t5 was reduced (32.94±0.36 vs. 36.8±1.30, p<0.01), Maximum amplitude was increased (655.7±9.19 vs. 547±19.38, p<0.001), Intensity of total coagulation was increased (19.41±0.34vs.15,09±0.56, p<0.001), Intensity of clot retraction and lysis was increased (4.1±0.07vs.3±0.15, p<0.001) and Coefficient of total anticoagulant activity was increased (2.81±0.05 vs. 2.48 ± 0.06, p<0.001) compared to liver cirrhosis. Conclusions: In patients with liver cirrhosis and atrial fibrillation the hemostatic potential is significantly shifted towards hypercoagulation with a gradual worsening of coagulation disorders, starting from the compensated stage of liver cirrhosis.

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