Diverse Utility of Endogenous Thrombin Potential and Thromboelastometry in the Assessment of Patients with Alcoholic Cirrhosis

Abstract

Background and rationale: Diagnosis and treatment of a wide spectrum of abnormalities in the coagulation system in patients suffering from cirrhosis still remain a challenge to physicians. Using endogenous thrombin potential (ETP) method and thromboelastometry, we assessed coagulation profile in 60 adult patients with alcoholic cirrhosis and 50 healthy subjects. We evaluated coagulation profile of patients with these global hemostatic methods, link between ETP/thromboelastometry profiles and standard coagulation tests, relationship between ETP and thromboelastometry parameters with different degrees of liver lesions and correlation between these assays and biochemical liver function. Main results: In most patients, ETP parameters were consistent with the hypocoagulable profile. The majorities of patients were identified as having decreased Cmax (n=55/60) and AUC (n=49/60) as well as increased t-lag values (n=39/60). There was significance between ETP parameters in two groups (p<0.001). The t-lag was higher in cirrhosis (30.1±10.8 vs. 25.6±14.2s). Both Cmax (peak height) and AUC (area under the curve) were higher in controls (112.0±20.9 vs. 98.3±10.9%; 68.3±28.2 vs. 67.9±16.4%). AUC correlated with cholinesterase (r=0.610; p<0.001), albumin (r=0.462; p<0.001), and total bilirubin (r=-0.281; p=0.031). Using thromboelastometry, we found hypocoagulability represented by reduced MCF (maximum clot firmness) in 33.3% (n=20/60) of patients in extrinsic, and 41.7% (n=25/60) of patients in intrinsic activated test. In patients, CFT (clot formation time) values were significantly higher, whereas MCF values were lower (extrinsic test: 116.6±45.6 vs. 79.2±16.9s; 55.9±8.9 vs. 66.2±4.0mm; p<0.001) compared to controls. There was a weak correlation (r=0.272; p=0.037) between cholinesterase activity and MCF in extrinsic test. Conclusion: ETP may be an additional alternative for estimating impairment of synthesis liver function and severity degree of cirrhosis caused by alcohol. Thromboelastometry is superior to ETP for investigating coagulopathy in cirrhosis as it provides supplemental information such as maximum clot firmness and stability.