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Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients.
J Crit Care Med (Targu Mures). 2018 Jul; 4(3):90-95.JC

Abstract

Introduction

Cirrhotic patients have been considered for decades to have a pro-haemorrhagic pattern and were treated as such based on the results from standard coagulation tests. The aim of our study was to determine the effects of platelet count and fibrinogen levels on rotational thromboelastometry (ROTEM) parameters.

Methods

We prospectively included 176 patients with End-Stage Liver Disease (ESLD) admitted to our Intensive Care Unit prior to liver transplantation. Collected data consisted of severity scores, liver, renal and standard coagulation tests, fibrinogen levels, platelet counts and ROTEM parameters. Four ROTEM assays were performed (ExTEM, InTEM, ApTEM and FibTEM) and the following parameters included: CT - clotting time, CFT - clot formation time, MCF - maximum clot firmness, ML - maximum lysis, alpha angle, TPI - thrombin potential index, MaxV - maximum velocity of clot formation (MaxV), MaxVt - time to MaxV, MCE - maximum clot elasticity and AUC - area under the curve.

Results

Statistical analysis demonstrated a linear correlation between platelet counts and ExTEM TPI (R2 linear =0.494), ExTEM MaxV (R2 linear =0.253), ExTEM MCE (R2 linear = 0.351) and ExTEM MCF (R2 cubic = 0.498). Fibrinogen levels correlated linearly with ExTEM MCF (R2 linear = 0.426), ExTEM TPI (R2 linear = 0.544), ExTEM MaxV (R2 linear = 0.332), ExTEM MCE (R2 linear = 0.395) and non-linearly with ExTEM CFT (R2 cubic = 0.475).

Conclusion

Fibrinogen levels and platelet counts had an important effect on both standard and derived ROTEM parameters. Further analysis is required in order to determine clinically oriented cut-off values below which severe coagulopathy would develop.

Authors+Show Affiliations

"Carol Davila" University of Medicine and Pharmacy, Department of Anaesthesia and Critical Care Medicine, Bucharest, Romania. Fundeni Clinical Institute, Anaesthesia and Critical Care Department III, Bucharest, Romania."Carol Davila" University of Medicine and Pharmacy, Department of Anaesthesia and Critical Care Medicine, Bucharest, Romania. Fundeni Clinical Institute, Anaesthesia and Critical Care Department III, Bucharest, Romania.Department of Anesthesiology & Pain, Medicine, University of Washington Medical Center, Seattle WA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30582001

Citation

Tomescu, Dana, et al. "Effects of Fibrinogen Levels and Platelet Counts On Viscoelastic Testing in Cirrhotic Patients." Journal of Critical Care Medicine (Universitatea De Medicina Si Farmacie Din Targu-Mures), vol. 4, no. 3, 2018, pp. 90-95.
Tomescu D, Popescu M, Vitin A. Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients. J Crit Care Med (Targu Mures). 2018;4(3):90-95.
Tomescu, D., Popescu, M., & Vitin, A. (2018). Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients. Journal of Critical Care Medicine (Universitatea De Medicina Si Farmacie Din Targu-Mures), 4(3), 90-95. https://doi.org/10.2478/jccm-2018-0012
Tomescu D, Popescu M, Vitin A. Effects of Fibrinogen Levels and Platelet Counts On Viscoelastic Testing in Cirrhotic Patients. J Crit Care Med (Targu Mures). 2018;4(3):90-95. PubMed PMID: 30582001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients. AU - Tomescu,Dana, AU - Popescu,Mihai, AU - Vitin,Alexander, Y1 - 2018/07/01/ PY - 2018/02/26/received PY - 2018/05/02/accepted PY - 2018/12/25/entrez PY - 2018/12/26/pubmed PY - 2018/12/26/medline KW - cirrhotic coagulopathy KW - fibrinogen levels KW - platelet count KW - rotational thromboelastometry SP - 90 EP - 95 JF - Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) JO - J Crit Care Med (Targu Mures) VL - 4 IS - 3 N2 - Introduction: Cirrhotic patients have been considered for decades to have a pro-haemorrhagic pattern and were treated as such based on the results from standard coagulation tests. The aim of our study was to determine the effects of platelet count and fibrinogen levels on rotational thromboelastometry (ROTEM) parameters. Methods: We prospectively included 176 patients with End-Stage Liver Disease (ESLD) admitted to our Intensive Care Unit prior to liver transplantation. Collected data consisted of severity scores, liver, renal and standard coagulation tests, fibrinogen levels, platelet counts and ROTEM parameters. Four ROTEM assays were performed (ExTEM, InTEM, ApTEM and FibTEM) and the following parameters included: CT - clotting time, CFT - clot formation time, MCF - maximum clot firmness, ML - maximum lysis, alpha angle, TPI - thrombin potential index, MaxV - maximum velocity of clot formation (MaxV), MaxVt - time to MaxV, MCE - maximum clot elasticity and AUC - area under the curve. Results: Statistical analysis demonstrated a linear correlation between platelet counts and ExTEM TPI (R2 linear =0.494), ExTEM MaxV (R2 linear =0.253), ExTEM MCE (R2 linear = 0.351) and ExTEM MCF (R2 cubic = 0.498). Fibrinogen levels correlated linearly with ExTEM MCF (R2 linear = 0.426), ExTEM TPI (R2 linear = 0.544), ExTEM MaxV (R2 linear = 0.332), ExTEM MCE (R2 linear = 0.395) and non-linearly with ExTEM CFT (R2 cubic = 0.475). Conclusion: Fibrinogen levels and platelet counts had an important effect on both standard and derived ROTEM parameters. Further analysis is required in order to determine clinically oriented cut-off values below which severe coagulopathy would develop. SN - 2393-1809 UR - https://www.unboundmedicine.com/medline/citation/30582001/Effects_of_Fibrinogen_Levels_and_Platelet_Counts_on_Viscoelastic_Testing_in_Cirrhotic_Patients_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30582001/ DB - PRIME DP - Unbound Medicine ER -
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