Evaluation of Thromboelastography Parameters and Conventional Coagulation Assays for Predicting Bleeding in Severe Hepatic Cirrhosis

International Journal of Medicine and Medical Sciences | Vol. 13, No. 1, January 2023 | pp. 1–8

DOI: 10.46882/2023/IJMMS/130001

Original Research Article

Evaluation of Thromboelastography Parameters and Conventional Coagulation Assays for Predicting Bleeding in Severe Hepatic Cirrhosis

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Conventional coagulation parameters such as the International Normalized Ratio (INR) often fail to reflect the true complex hemostatic state of patients with hepatic cirrhosis. This prospective clinical study evaluated the utility of Thromboelastography (TEG) parameters compared to conventional coagulation assays (CCA) for predicting acute variceal bleeding events in patients with severe hepatic cirrhosis. We enrolled 110 adult patients with confirmed Child-Pugh Class B or C hepatic cirrhosis. Baseline TEG variables (R-time, K-time, alpha angle, and maximum amplitude [MA]) and CCA profiles (INR, activated partial thromboplastin time, and platelet count) were measured at admission, and patients were monitored for 6 months for any significant gastrointestinal bleeding events. Over the follow-up period, 28 patients experienced acute bleeding events (25.5%). In the bleeding group, the TEG maximum amplitude (MA)—a marker of platelet-fibrin clot strength—was significantly lower (42.4 ± 5.1 mm) compared to non-bleeding patients (56.8 ± 6.4 mm, p < 0.001). Conversely, baseline INR values did not show a statistically significant difference between bleeding and non-bleeding cohorts (mean = 2.1 ± 0.4 vs. 1.9 ± 0.3, p = 0.24). Receiver Operating Characteristic (ROC) analysis showed that a TEG MA cutoff value < 45 mm predicted bleeding with a sensitivity of 89.3% and a specificity of 81.7% (AUC = 0.89), significantly outperforming the INR (AUC = 0.62, p < 0.01). Thromboelastography parameters provide a more accurate evaluation of bleeding risks in cirrhotic patients than conventional clotting assays. Utilizing viscoelastic testing can improve clinical management and guide targeted blood product utilization.

Keywords: Hepatic Cirrhosis, Thromboelastography, Variceal Bleeding, Hemostasis, International Normalized Ratio, Platelet Function

Manuscript Timeline: Received: October 14, 2022; Revised: November 24, 2022; Accepted: December 16, 2022; Published: January 13, 2023.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of Thromboelastography Parameters and Conventional Coagulation Assays for Predicting Bleeding in Severe Hepatic Cirrhosis. International Journal of Medicine and Medical Sciences, 2023, 13(1): 1–8. DOI: 10.46882/2023/IJMMS/130001

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