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. 2022 Dec 13;20(1):75.
doi: 10.1186/s12959-022-00438-3.

Haemostasis patterns in patients with acute-on-chronic liver failure and acute decompensation of cirrhosis including thromboelastometric tests with and without the addition of Protac: a pilot study

Andrea Calvo  1 , Miguel Angel Torrente  2 , Klaus Görlinger  3   4 , Javier Fernandez  5 , Enric Reverter  5 , Julia Vidal  6 , Dolors Tassies  2 , Jordi Colmenero  5 , Annabel Blasi #  7 , Juan Carlos Reverter #  2
Affiliations

Haemostasis patterns in patients with acute-on-chronic liver failure and acute decompensation of cirrhosis including thromboelastometric tests with and without the addition of Protac: a pilot study

Andrea Calvo et al. Thromb J. .

Abstract

Background: Thromboelastometry is considered the best method to assesses hemostasis in liver disease. Diagnostic performance could be improved by adding protein C activators such as thrombomodulin or Protac®. We assessed changes in ROTEM parameters after the addition of Protac® in patients with acute-on-chronic liver failure (ACLF), acute decompensation (AD), and healthy individuals (HI) to define different hemostasis patterns, considering standard and velocity ROTEM parameters, and assess whether Protac® can improve the definition of the pattern.

Methods: Pre-test, we investigated whether diluted EXTEM reagent improved the effect of Protac® on the clotting time (CT)-ratio with and without Protac®. Ten ACLF and 20 AD patients and 21 HI were included in the main study.

Results: Standard EXTEM was used in the main study. INTEM CFT, INTEM A5 (inverse), and INTEM TPI (inverse) were the parameters that best differentiated liver disease from HI (ROC AUC, 0.921, 0.906, and 0.928, respectively; all P-values < 0.001). Combining INTEM CFT with EXTEM LI60-ratio only slightly improved the diagnostic performance (ROC AUC, 0.948; P < 0.001). EXTEM LI60 and INTEM maxV-t were the parameters that best differentiated between ACLF and AD patients (ROC AUC, 0.743, P = 0.033; and 0.723, P = 0.050; respectively). Combining EXTEM LI60 + INTEM maxV-t moderately improved the diagnostic performance (ROC AUC, 0.81, P < 0.001).

Conclusions: ROTEM velocity, fibrinolysis parameters and the indices calculated improve the diagnosis in combination with standard parameters (e.g., CFT and A5). Ratios calculated with and without Protac® (e.g., EXTEM LI60-ratio) only slightly increased the diagnostic performance in discriminating hemostasis patterns.

Keywords: Cirrhosis; Haemostasis; Protac; Protein C; Thromboelastometry; Thrombomodulin.

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Conflict of interest statement

Klaus Görlinger is the medical director of TEM innovations gmbh, Munich, Germany. The others authors declare they have no competing interests.

Figures

Fig.1
Fig.1
HEALTHY VS DISEASE. INTEM CFT 0.921
Fig. 2
Fig. 2
HEALTHY VS DISEASE. INTEM A5 (inverse) 0.906
Fig. 3
Fig. 3
HEALTHY VS DISEASE INTEM TPI (inverse) 0.928
Fig. 4
Fig. 4
AD VS ACLF EXTEM LI60 0.743
Fig. 5
Fig. 5
AD VS ACLF INTEM maxV-t 0.723
Fig. 6
Fig. 6
AD VS ACLF EXTEM LI60 + INTEM maxV-t 0.81
Fig. 7
Fig. 7
HEALTHY VS DISEASE INTEM CFT / EXTEM LI60-ratio 0.948
See this image and copyright information in PMC

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