Heparin effect on thromboelastography after transjugular intrahepatic portosystemic shunt procedure.
OBJECTIVE
In patients with cirrhosis and bacterial infection there is impaired coagulation and a heparin effect on thromboelastography (TEG). Our aim was to assess the presence of a heparin effect on heparinase I-modified TEG in patients before and after transjugular intrahepatic portosystemic shunt (TIPS). Our hypothesis was that, given the presence of a portosystemic gradient of endotoxaemia, and the role of endotoxaemia on the release of heparinoids, the inflow of portal blood after TIPS might reveal heparinoids through a heparin effect on TEG.


METHODS
Blood samples for heparinase I-modified TEG were taken before, 1 h after, 6 h after and the morning after TIPS, with further daily samples being taken until any TEG changes had reverted to baseline. A heparin effect was defined as an improvement of > or =20% in a TEG variable after addition of heparinase I.


RESULTS
We studied 10 patients (six males, mean age 48.8 years, mean Child score 8.8). The aetiology of liver disease was alcohol in six patients, Budd-Chiari syndrome in two, and hepatitis C virus and cryptogenic cirrhosis in one each. Indications for TIPS were recurrent variceal bleeding in four patients, refractory ascites or hydrothorax in four and Budd-Chiari syndrome in two. There was a statistically significant worsening in TEG parameters after TIPS placement. In eight patients a heparin effect appeared after TIPS and disappeared within 24-48 h.


CONCLUSIONS
We report the appearance of a transient heparin effect in systemic venous blood after TIPS in patients with cirrhosis or Budd-Chiari syndrome, suggesting the presence of heparinoid substances in the portal venous system in these patients.
Thalheimer
Ulrich
U
The Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK. uthalheimer@gmx.net
Triantos
Christos
C
Samonakis
Dimitrios
D
Patch
David
D
Burroughs
Andrew K
AK
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D019763:Heparin Lyase / Q000187:drug effects*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D008107:Liver Diseases / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011184:Postoperative Period; D057234:Preoperative Period; D012307:Risk Factors; D013916:Thrombelastography / Q000187:drug effects*; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin; D019763:Heparin Lyase