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Study of Hemostatic control in chronic liver disease patient utilising Thromboelastography and clot waveform analysis

Anjali Jose, Geeta Vidyadharan, Shine Sadasivan, Greeshma C Ravindran, Renjitha Bhaskaran, Anju Gopinath, Bitty Kurian

Background: The Hemostatic pathways are generally altered in patients with liver dysfunction. Chronic Liver Diseases (CLD) results in reduced synthesis of Pro-coagulant along with anticoagulant factors and is also related to reduce level of platelet number and function. In Rebalanced hemostasis the defects in pro hemostatic contributors are compensated by complex changes in the anti-hemostatic factors. Global Coagulation Assays (GCA) provides a composite picture of clot dynamics. Our intention was to understand significance of GCA and correlation of Thromboelastography and clot waveform parameters among different subsets of CLD patients. Method: Prospective study of 74 patients from gastroenterology department in Amrita institute of medical sciences with diagnosis of CLD subcategorized into CHILD class was enrolled in our study. Blood collected in two blue tubes from each patient. One sample is centrifuged to attain platelet poor plasma further assessed in DT-100 /Tcoag optical analyzer and the parameters min1, min2 and max2 of PT and APTT waveform were recorded. TEG analysis done from citrated whole blood (2nd sample) using kaolin as activator. The software processed graph reflecting the kinetics and strength of clot, with clot lysis and the values R (Reaction time), Kinetics (K), alpha angle, Maximum Amplitude (MA), clot lysis (ly30) and Coagulation Index (CI) were collected. Results: Extrapolation of individual parameters of GCA showed that parameters min 1 and min 2 of APTT waveform, max2 of PT waveform and TEG parameters such as MA and K showed statistically significant difference from CHILD A – CHILD C disease spectrum. Also, significant correlation between the TEG parameters like Maximum Amplitude (MA), angle, Reaction Time with clot wave form parameters such min 1, min2 and max2 of PT and APTT waveform were attained. Conclusion: TEG and CWA provides a better understanding about the clot strength and dynamics which could be exploited to analyses the homeostatic control in different subsets of CLD patients