Usefulness of thromboelastometry in predicting the risk of bleeding in cirrhotics who undergo invasive procedures
Usefulness of thromboelastometry in predicting the risk of bleeding in cirrhotics who undergo invasive procedures
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DOI：
10.1097/meg.0000000000000442
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发表时间：
2015-11-01
影响因子：
2.1
通讯作者：
Marzano, Alfredo
中科院分区：
文献类型：
--
作者：
Venon, Wilma Debernardi;Ponzo, Paola;Marzano, Alfredo
目的肝硬化患者行侵入性手术的处理存在争议，常规实验室检查不适合进行止血评估。我们评估了以下内容：（a）血栓弹性测定法预测出血的风险，在接受侵入性手术的血栓患者，并使一个决定的预防性输血策略;（B）的贡献，血小板粘附和聚集试验在评估haemostasis.Patients和方法17例接受侵入性手术的血栓患者进行了回顾性分析（训练集）。为了获得初步数据，在58例患者中进行了观察性研究（测试集）。所有75例患者均进行了血栓弹性测定。采用Multiplate、PFA-100和光透射聚集测定法对16例患者的血小板粘附和聚集进行了评价。因子VIII给药的所有患者的测试set.Results在训练集，血栓弹性测定证实了止血评估所示的常规测试仅在6/17（35%）的患者。在测试集中，血栓弹性测定确定了所有发生出血事件的患者。在出血风险高的患者中，使用血栓弹性测定法具有成本效益，可减少64%的血小板输注。血小板粘附/聚集异常15/16例（94%），出血事件仅2/15例（13%）。结论血栓弹性分析可用于筛选行侵入性操作的血栓患者，以确定出血风险和优化输血策略。粘附/聚集试验在识别有出血风险的患者方面没有用，并且其应用不具有成本效益。版权所有（C）2015威科医疗集团All rights reserved.
Objectives The management of patients with liver cirrhosis undergoing invasive procedures is controversial and haemostasis assessment using routine laboratory is inappropriate. We evaluated the following: (a) the ability of thromboelastometry to predict the risk of bleeding in cirrhotic patients undergoing invasive procedures and enable a decision on the prophylactic transfusional strategy; (b) the contribution of platelet adhesion and aggregation tests in the assessment of haemostasis.Patients and methods Seventeen cirrhotic patients undergoing invasive procedures were analyzed retrospectively (training set). To obtain preliminary data, an observational study was carried out in 58 patients (test set). All 75 patients were evaluated by thromboelastometry. Platelet adhesion and aggregation were evaluated in 16 patients using Multiplate, PFA-100 and Light Transmission Aggregometry. Factor VIII was dosed in all patients of the test set.Results In the training set, thromboelastometry confirmed the haemostatic assessment shown by the conventional test only in 6/17 (35%) patients. In the test set, thromboelastometry identified all patients who had a bleeding event. In patients with a high risk of bleeding, the use of thromboelastometry was cost-effective, reducing the platelet infusions by 64%. Platelet adhesion/aggregation abnormalities were observed in 15/16 (94%) patients, but bleeding events occurred only in 2/15 (13%) patients.Conclusion Thromboelastometry appears to be useful to screen cirrhotic patients undergoing invasive procedures to identify the risk of bleeding and to optimize the transfusional strategy. Adhesion/aggregation tests are not useful in identifying patients at risk of bleeding and their application is not cost-effective. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.