Evaluation Of Coagulation Status In Patients With Cirrhosis By Thromboelastography

Objective:The purpose of this study is to analyze the role of Thromboelastography in the assessment of coagulation status in patients with cirrhosis,to explore the different characteristics of thrombelastogram in different stages of cirrhosis and bleeding and thrombosis with conventional coagulation indexes,so as to further guide the clinical practice.Methods:According to the inclusion and exclusion criteria,57 patients with liver cirrhosis were included who were hospitalized in the department of geriatric gastroenterology of Hebei General Hospital from April 2022 to November 2022.Collected General data of patients: age,sex,etiology of liver cirrhosis,cause of bleeding,site of thrombus formation;laboratory tests: blood analysis,comprehensive biochemical items,conventional coagulation tests,thromboelastography;imaging examinations: lower extremity venous ultrasound,abdominal ultrasound,abdominal CT or MRI.1 Classify according to the Child-Pugh score of liver function,Child-Pugh class A is the compensation period,Child-Pugh class B and class C are the decompensation period.Compare the differences of the conventional coagulation tests and thromboelastography parameters in the peripheral blood between the compensation period and the decompensation period.Compare the differences of the conventional coagulation tests and thromboelastography parameters in the peripheral blood among the Child-Pugh class A,class B,and class C.2 Patients were divided into bleeding group and non-bleeding group according to whether they had symptoms of gastrointestinal bleeding when they were admitted to the hospital,and compare the differences of the conventional coagulation tests and thromboelastography parameters in the peripheral blood between the two groups.3 Combined with imaging examination,the patients were divided into thrombus group and non-thrombus group according to whether they were combined with thrombus formation,and compare the differences of the conventional coagulation tests and thromboelastography parameters in the peripheral blood between the two groups.Results:1 Total data: Among the 57 patients with liver cirrhosis,there were 20 cases of Child-Pugh A class,24 cases of Child-Pugh B class,and 13 cases of Child-Pugh C class.There were 20 liver cirrhosis patients(35.1%)with hemorrhage.There were 20 liver cirrhosis patients(35.1%)withthrombosis.The PLT and MA of patients with liver cirrhosis were lower than normal,and D-D was higher than normal.2 Compared with patients with liver cirrhosis in compensated phase,patients with decompensated phase had prolonged PT,decreased FIB,increased D-D,and shortened R,and the difference was statistically significant(P<0.05).With the increase of liver function grade,PT,APTT,TT of patients with liver cirrhosis gradually prolong,FIB gradually decreases,and D-D gradually increases,the difference is statistically significant(P<0.05);The R of Child-Pugh class B patients was significantly shorter than that of Child-Pugh class A patients(P<0.05),the K was shortened,and the α,MA,and CI were all increased,also suggested a hypercoagulation trend,but the difference was not statistically significant(P>0.05);Child-Pugh class C patients compared with the Child-Pugh class B,the R and K were prolonged,and the α,MA and CI were all decreased,all indicate a low coagulation trend,but the difference was not statistically significant(P>0.05).3 Compared with the no bleeding group,the bleeding group APTT and R of the bleeding group were shortened,and the difference was statistically significant(P<0.05),the K was shortened,and the α,MA and CI increased,but the difference was not statistically significant(P>0.05);the proportion of the hypercoagulable state represented by the shortened R in the bleeding group was significantly higher than that of the no bleeding group(50.0% vs 21.6%,P<0.05).Compared with normal,the proportion of hypercoagulability represented by shortened K,increased α,MA and CI was not statistically different between the two groups(5.0%,5.0%,5.0%,5.0% vs 0.0%,5.4%,0.0%,0.0%,P>0.05).Compared with normal,the proportion of low coagulation represented by prolonged R,K,decreased α,MA and CI did not differ significantly between the two groups(0.0%,30.0%,25.0%,50.0%,30.0% vs 0.0%,45.9%,29.7%,67.6%,48.6%,P>0.05).4 Compared with the no thrombus group,the thrombus group PLT and FIB increased,PT,APTT,TT shortened,D-D increased,R shortened,K prolonged,α decreased,MA and CI increased,but the difference was not statistically significant(P>0.05).Compared with normal,the proportion of hypercoagulants represented by shortened R,K,increased α,MA,and CI(40.0%,0.0%,0.0%,0.0%,0.0% vs 27.0%,2.7%,8.1%,2.7%,P>0.05),and low coagulation represented by prolonged R,K,decreased α,MA,and CI did not show statistical difference in either group(0.0%,40.0%,15.0%,55.0%,35.0% vs 0.0%,40.5%,35.1%,64.9%,45.9%,P>0.05).Conclusion:1 The total level of TEG parameters in cirrhosis patients is basically normal,reflecting the general preservation of the organism coagulation system function when cirrhosis occurs;2 The lack of coagulation factors is more obvious during the decompensation stage of cirrhosis,and the relatively shortened R value suggests that patients with the decompensated liver cirrhosis may compensate for the lack of their quantity by increasing the activity of blood coagulation factors to maintain blood coagulation balance3 The vast majority of TEG parameters in patients with bleeding and no bleeding,so the occurrence of bleeding events in cirrhosis patients may be more dependent on the increase of portal vein pressure than coagulation dysfunction;4 Conventional coagulation tests and TEG parameters were not significantly different in cirrhosis patients with and without thrombosis,and neither could predict the risk of thrombosis in liver cirrhosis,and blood hypercoagulability may not be the main cause of thrombosis in patients with liver cirrhosis.