Thrombelastographic changes and early rebleeding in cirrhotic patients with variceal bleeding.
BACKGROUND
Routine coagulation tests do not necessarily reflect haemostasis in vivo in cirrhotic patients, particularly those who have bleeding varices. Thrombelastography (TEG) can provide a global assessment of haemostatic function from initial clot formation to clot dissolution.


OBJECTIVE
To evaluate TEG changes in cirrhotic patients with variceal bleeding and their association with early rebleeding.


METHODS
Twenty cirrhotic patients with active variceal bleeding had serial TEG and routine coagulation tests daily for seven days. The TEG variables before the day of rebleeding (n = 6) were compared with those of patients without rebleeding (n = 14).


RESULTS
Baseline characteristics of the rebleeding and non-rebleeding groups were comparable apart from a higher incidence of uncontrolled infection on the day of rebleeding in the rebleeding group (p = 0.007). The patients in the rebleeding group were more hypocoagulable before the day of rebleeding as shown by longer r (42 v 24 mm, p < 0.001) and k (48 v 13 mm, p < 0.001) and smaller a (12 v 38 degrees, p < 0.001) compared with the mean of daily results of the non-rebleeding group. Routine coagulation tests, however, showed no significant differences between the two groups.


CONCLUSIONS
The results of serial TEG measurements suggest that hypocoagulability may be associated with early rebleeding in cirrhotic patients.
Chau
T N
TN
Department of Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK.
Chan
Y W
YW
Patch
D
D
Tokunaga
S
S
Greenslade
L
L
Burroughs
A K
AK
D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D004932:Esophageal and Gastric Varices / Q000097:blood*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood*; D006487:Hemostasis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013916:Thrombelastography / Q000379:methods*