No Differences in Rotational Thromboelastometry Measurements between Portal and Peripheral Circulation in Cirrhotic Patients Undergoing TIPS

Sotiria Bedreli; Paul Manka; Matthias Buechter; Michael Jahn; Jens M Theysohn; Ali Canbay; Antonios Katsounas

doi:10.3390/jpm13030424

No Differences in Rotational Thromboelastometry Measurements between Portal and Peripheral Circulation in Cirrhotic Patients Undergoing TIPS

J Pers Med. 2023 Feb 26;13(3):424. doi: 10.3390/jpm13030424.

Authors

Sotiria Bedreli¹, Paul Manka^{2

3}, Matthias Buechter⁴, Michael Jahn⁵, Jens M Theysohn⁶, Ali Canbay^{2

3}, Antonios Katsounas^{2

3

7}

Affiliations

¹ Department of Internal Medicine and Gastroenterology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany.
² Department of Medicine, University Hospital Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany.
³ Faculty of Medicine, Ruhr University Bochum, 44901 Bochum, Germany.
⁴ Department of Medicine and Gastroenterology, Katholische Kliniken im Märkischen Kreis gem, GmbH, 58638 Iserlohn, Germany.
⁵ Department of Nephrology, Alfried-Krupp Krankenhaus Essen, 45131 Essen, Germany.
⁶ Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany.
⁷ Division Infectious Diseases and Critical Care Medicine, Department of Medicine, University Hospital Knappschaftskrankenhaus, 44892 Bochum, Germany.

Abstract

Background: In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) is considered a standardized treatment of refractory ascites or variceal bleeding. TIPS thrombosis (TT) and/or portal vein thrombosis (PVT) are possible complications during/after TIPS placement. Previous studies suggested increased clotting activity in portal circulation (PORC). This pilot study aimed to evaluate alterations and differences of coagulation function in PORC and in peripheral circulation (PERC) via rotational thromboelastometry during TIPS.

Methods: Blood samples were collected from cirrhotic patients (n = 13; median Model of End Stage Liver Disease, MELD Score: 12; median age: 60 years) undergoing TIPS (10/13 TIPSs were elective procedures due to refractory ascites) as follows: median cubital vein (MCV; PERC)-confluence of the three hepatic veins to the inferior cava vein (HV/ICV; PORC)-portal vein (PV; PORC)-TIPS (PORC). This research utilized four variables of the extrinsic test EXTEM, i.e., clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and maximum lysis (ML).

Results: EXTEM results [mean, M (range) ± standard deviation, SD (range)] showed no significant differences for CT [M (70-73) ± SD (9-13); p = 0.93] or CFT [M (137-155) ± SD (75-112); p = 0.97] or MCF [M (51-54) ± SD (9-10); p = 0.90] or ML [M (9-10) ± SD (4-5); p = 0.89] between the compartments, i.e., MCV vs. HV/ICV vs. PV vs. TIPS. Overall, we detected no differences in coagulation function between PERC and PORC.

Conclusion: These results are in contrast to previous reports suggesting increased clotting activity in PORC vs. PERC in association with liver cirrhosis. Rotational thromboelastometry-based evaluation of coagulation function in PERC appears to reliably reflect coagulation function in PORC with respect to risk estimation for TT and/or PVT in cirrhotic patients undergoing TIPS.

Keywords: ROTEM®; TIPS; hepatic decompensation; hypercoagulable state; liver disease; portal hypertension; thrombosis risk assessment.

Grants and funding

The authors declare that no funds, grants, or other supports were received during preparation of this manuscript.