title: Coagulation in acutely ill patients with severe chronic liver disease: Insights from thromboelastography.
abstract: There is controversy about the true coagulation state of acutely ill patients with chronic liver disease (CLD) due to simultaneous pro- and anticoagulant factor deficits and limitations of conventional coagulation tests (CCTs). Thromboelastography (TEG) may provide more physiologically relevant insights.
  
  
  
  In acutely ill patients with severe (Child-Pugh C) CLD, we conducted a prospective observational study of daily coagulation assessment with both CCTs and TEG.
  
  
  
  We studied 34 patients with CLD on a total of 109 occasions (median of 3 samples per patient), comparing findings with 157 healthy controls. Conventional coagulation tests and TEG both demonstrated clear hypocoagulability. Thromboelastography-confirmed delayed clot formation was demonstrated by longer reaction time (1.1 minutes vs 0.6 minutes on rapid TEG; P<.01), longer kinetic time (2.9 minutes vs 1.3; P<.01), more acute α angle (65° vs 72.2°; P<.01), and longer activated clotting time (157 seconds vs 105 seconds; P<.01). Patients with CLD demonstrated weaker thrombus strength (maximum amplitude, 43.3 mm vs 61.8 mm; P<.01) and reduced clot lysis (0% vs 1% on rapid TEG; P<.01).
  
  
  
  In acutely ill patients with CLD, TEG demonstrates delayed clot formation and weaker thrombus strength despite decreased clot lysis. This challenges the notion that such patients experience a balanced coagulation state, highlighting the complexity of their coagulopathies.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Patryck
authors.initials: P
authors.lastname: Lloyd-Donald
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Vasudevan
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Angus
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Gow
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna SE-171 77, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm SE-171 77, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Mårtensson
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Glassford
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Graeme K
authors.initials: GK
authors.lastname: Hart
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Department of Intensive Care, Austin Hospital, Melbourne, Australia.. Electronic address: rinaldo.bellomo@austin.org.au.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013916:Thrombelastography
keywords: Coagulopathy; Global coagulation assays; Hepatic cirrhosis; Thromboelastography