PB0483 - Can Thrombin Generation Assay Predict Bleeding Risk in Patients with Severe Liver Failure?

Background: Coagulopathy in liver failure may maintain a balanced state. Disruption of this balance will cause increased bleeding or thrombotic risks. Assessment of bleeding risk is essential to prevent undesired bleeding episodes or unnecessary therapy. Routine coagulation tests show poor correlation with bleeding risk in liver failure. Thrombin generation assay (TGA) provides unique perspective of coagulation and may be of benefit in this population.

Aims: Comparing standard coagulation assays with TGA and viscoelastometry to assess their correlation with bleeding.

Methods: After IRB approval, citrated plasma samples from 10 liver patients at a tertiary pediatric hospital were included in this descriptive study. Data were collected from routine hemostasis tests including international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, and platelet count. TGA was performed using Genesia (Diagnostica Stago, USA) and viscoelastometry was performed via ROTEM (Werfen, USA). TGA values were reported as ratio or percentage of the reference plasma. Clinical bleeding episodes were obtained from electronic medical records. Descriptive statistics and ANOVA performed. Results were reported in mean+/-SD.

Results: Median age was 4.5 (IQR 0.8-15) years and female 60%. Thirty nine percent of samples were associated with bleeding episodes, ranging from mucocutaneous to intracranial hemorrhage. Samples were divided into two groups based on association with bleeding episodes. Results are presented in Table 1. D-dimer, TGA lag time and EXTEM clotting time (CT) showed an association with bleeding episodes. Other parameters were not associated with bleeding episodes.

Conclusion(s): TGA lag time, EXTEM CT and D-dimer can potentially be utilized as a predictive tool to assess bleeding risk in coagulopathy secondary to liver failure. Notably, INR did not show correlation with bleeding episodes. Further studies are warranted to assess utility of TGA and ROTEM in liver failure.