K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis: A pilot study.
Chandra Kant Pandey,Vandana Saluja,Kumar Gaurav,Manish Tandon,Vijay Kant Pandey,Ajeet S Bhadoria +5 more
TLDR
The results show that the cut-off value for INR ≥2.6 and K time ≥3.05 min predicts bleeding and MA ≥48.8 mm predicts non-bleeding in patients with cirrhosis undergoing central venous pressure catheter cannulation.Abstract:
Background & objectives: Coagulation and haemostasis are dynamic processes. The haemostatic changes in liver disease affect all aspects of coagulation. The prothrombin time (PT)/ international normalized ratio (INR) was developed to monitor oral anticoagulant therapy and the activated partial thromboplastin time to investigate inheritable single factor deficiencies. Viscoelastic tests such as thromboelastogram (TEG) give information about dynamics of clot formation (coagulation factor and anticoagulant activity), clot strength (platelets and fibrinogen) and clot stability (finbrinolysis and factor XIII). Administration of blood products before invasive procedures is still guided by INR and platelet count in patients of liver disease. This study was aimed to evaluate the validity of TEG to predict post-procedural bleed after central venous cannulation in patients with cirrhosis. Methods: Ninety patients aged 20-70 yr diagnosed with liver cirrhosis requiring elective central venous catheter (CVC) insertion were studied. Platelet count, INR, serum creatinine, TEG and Child-Turcotte-Pugh (CTP) score were recorded before the procedure. Right-sided internal jugular vein was cannulated. On the basis of presence or absence of post-procedural bleed, patients were divided into bleeding and non-bleeding groups. The CTP score, component of TEG (R - reaction time, K - coagulation time, MA - maximum amplitude and α - angle) and laboratory parameters of both the groups were compared. Results: Bleeding was seen more when CTP scores were ≥10 (P=0.05). The K time of 3.05 min or more on thromboelastograph was a significant predictor of bleeding [area under the curve (AUC) 0.694, P=0.047]. MA of 48.8 mm or more was a significant predictor of non-bleeding. INR ≥2.6 was a significant predictor of bleeding (AUC 0.765, P=0.005). K time had a low-positive predictive value of 20 per cent and the positive and negative likelihood ratios of 1.87 and 0.48, respectively. Interpretation & conclusions: Our results show that the cut-off value for INR ≥2.6 and K time ≥3.05 min predict bleeding and MA ≥48.8 mm predicts non-bleeding in patients with cirrhosis undergoing central venous pressure catheter cannulation.read more
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EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis.
Erica Villa,Marcello Bianchini,Annabel Blasi,Alban Denys,Edoardo G. Giannini,Andrea De Gottardi,Ton Lisman,Emmanuelle de Raucourt,Cristina Ripoll,Pierre-Emmanuel Rautou +9 more
TL;DR: Hernandez-Gea et al. as discussed by the authors presented a set of guidelines for the prevention and management of bleeding and thrombosis in patients with cirrhosis, which are based on interventions that the panel feel are not useful, even though widely applied in clinical practice.
Journal ArticleDOI
ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs.
Cynthia R. L. Webster,John M. Cullen,Dominique G. Penninck,Keith Richter,David C. Twedt,Penny Watson +5 more
TL;DR: This consensus statement on chronic hepatitis in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH.
Journal ArticleDOI
Real-Time Ultrasound-Guided Subclavian Vein Cannulation Versus the Landmark Method in Critical Care Patients: A Prospective Randomized Study
Mariantina Fragou,Andreas Gravvanis,Vasilios Dimitriou,Apostolos Papalois,Gregorios Kouraklis,Andreas Karabinis,Theodosios Saranteas,John Poularas,John Papanikolaou,Periklis Davlouros,Nicos Labropoulos,Dimitrios Karakitsos +11 more
TL;DR: In this article, the authors compared the real-time ultrasound-guided subclavian vein catheterization vs. the landmark method in critical care patients and found that the ultrasound method was superior to the landmark one.
Journal ArticleDOI
The Misunderstood Coagulopathy of Liver Disease: A Review for the Acute Setting.
TL;DR: Despite the commonly accepted dogma that an elevated INR in a cirrhotic patient corresponds with an increased hemorrhagic risk during the performance of invasive procedures, the literature does not support this belief and the need for blood-product transfusion prior to an invasive intervention is not supported by the literature.
Journal ArticleDOI
Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis.
TL;DR: The limitations of both bleeding risk assessment in cirrhotic patients admitted to radiologic and endoscopic invasive procedures are described and whether preventive strategies indicated by current guidelines can affect the procedure-related hemorrhagic events are evaluated.
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The Coagulopathy of Chronic Liver Disease
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Journal ArticleDOI
Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence‐based review
Jodi B Segal,Walter H. Dzik +1 more
TL;DR: The literature was systematically reviewed to determine whether a prolonged prothrombin time or elevated international normalized ratio predicts bleeding during invasive diagnostic procedures.
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Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests.
Armando Tripodi,Francesco Salerno,Veena Chantarangkul,Marigrazia Clerici,Massimo Cazzaniga,Massimo Primignani,Pier Mannuccio Mannucci +6 more
TL;DR: In this paper, the authors used a thrombin generation test to investigate the coagulation function in patients with cirrhosis, and they found that the reduction of pro-coagulant factors in patients had little impact on the reduction in anticoagulants.
Journal ArticleDOI
Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences
Ton Lisman,Robert J. Porte +1 more
TL;DR: Arguments against the traditional concept that patients with liver failure have a hemostasis-related bleeding tendency are provided and new insights for hemostatic management will be discussed.
Journal ArticleDOI
Immune dysfunction and infections in patients with cirrhosis.
TL;DR: Bacterial overgrowth and translocation from the GI tract are important steps in the pathogenesis of SBP and bacteremia-these processes increase levels of endotoxins and cytokines that induce the inflammatory response and can lead to septic shock, multiorgan dysfunction, and death.