Evaluation of coagulation function by ROTEM in pre-/intra-/post-hepatic blood samples during TIPS-implantation in liver disease patients

Background In patients with liver cirrhosis, transjugular-intrahepatic-portosystemic-shunt (TIPS) is considered a standardized treatment of severe conditions, e.g., 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 evaluated the PORC and peripheral circulation (PERC) coagulation function using rotational-thromboelastometry (ROTEM) during TIPS.

Methods Blood samples were collected from cirrhotic patients (n=13) undergoing TIPS from the following compartments: median cubital vein (MCV; PERC) – the confluence of the three hepatic veins to the inferior cava vein (HV/ICV; PORC) – portal vein(PV; PORC) – TIPS (PORC).

Results EXTEM results 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. We detected no differences in coagulation function between the PERC and the PORC in patients with cirrhosis using ROTEM.

Conclusion The results of this pilot study contrast with previous reports suggesting increased clotting activity in the PORC vs. PERC in association with liver cirrhosis. ROTEM-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 among cirrhotic patients undergoing TIPS.

 

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Publication History

Article published online:
18 January 2023