title: Usefulness of thromboelastometry in predicting the risk of bleeding in cirrhotics who undergo invasive procedures.
abstract: OBJECTIVE
  The management of patients with liver cirrhosis undergoing invasive procedures is controversial and haemostasis assessment using routine laboratory is inappropriate. We evaluated the following: (a) the ability of thromboelastometry to predict the risk of bleeding in cirrhotic patients undergoing invasive procedures and enable a decision on the prophylactic transfusional strategy; (b) the contribution of platelet adhesion and aggregation tests in the assessment of haemostasis.
  
  
  METHODS
  Seventeen cirrhotic patients undergoing invasive procedures were analyzed retrospectively (training set). To obtain preliminary data, an observational study was carried out in 58 patients (test set). All 75 patients were evaluated by thromboelastometry. Platelet adhesion and aggregation were evaluated in 16 patients using Multiplate, PFA-100 and Light Transmission Aggregometry. Factor VIII was dosed in all patients of the test set.
  
  
  RESULTS
  In the training set, thromboelastometry confirmed the haemostatic assessment shown by the conventional test only in 6/17 (35%) patients. In the test set, thromboelastometry identified all patients who had a bleeding event. In patients with a high risk of bleeding, the use of thromboelastometry was cost-effective, reducing the platelet infusions by 64%. Platelet adhesion/aggregation abnormalities were observed in 15/16 (94%) patients, but bleeding events occurred only in 2/15 (13%) patients.
  
  
  CONCLUSIONS
  Thromboelastometry appears to be useful to screen cirrhotic patients undergoing invasive procedures to identify the risk of bleeding and to optimize the transfusional strategy. Adhesion/aggregation tests are not useful in identifying patients at risk of bleeding and their application is not cost-effective.
authors.affiliation: aDepartment of Medical Sciences, Division of Gastroenterology and Hepatology bDivision of Clinical Biochemistry, Divison of Hematology cCoagulation Laboratory, Division of Hematology, Molinette Hospital, Turin, Italy.
authors.forename: Wilma
authors.initials: W
authors.lastname: Debernardi Venon
authors.forename: Paola
authors.initials: P
authors.lastname: Ponzo
authors.forename: Marco
authors.initials: M
authors.lastname: Sacco
authors.forename: Giulio
authors.initials: G
authors.lastname: Mengozzi
authors.forename: Samuele
authors.initials: S
authors.lastname: Raso
authors.forename: Alessandra
authors.initials: A
authors.lastname: Valpreda
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010973:Platelet Adhesiveness; D010974:Platelet Aggregation; D010976:Platelet Count; D017713:Platelet Transfusion / Q000191:economics / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013916:Thrombelastography / Q000191:economics
chemical_list: D005169:Factor VIII