PhD Scientific Days 2025

Theoretical and Translational Medicine II.

Assessment of Coagulation by Viscoelastic Assays in Gastrointestinal Bleeding and Liver Disease

Name of the presenter

Fenyves Bánk

Institute/workplace of the presenter

Department of Emergency Medicine, Semmelweis University

Authors

Bánk Gábor Fenyves MD PhD¹, Judit Imecz MD¹, Viktória Hahn MD¹, Zoltán Rosta MD¹, Benedek Verburg MD¹, Gabriella Anna Rapszky MD¹, Árpád Patai MD², István Hritz MD², Tamás Berényi MD¹, Csaba Varga MD PhD¹

1: Department of Emergency Medicine, Semmelweis University
2: Department of Surgery, Transplantation and Gastroenterology, Semmelweis University

Text of the abstract

Introduction: The management of hemostasis in patients with liver disease and acute gastrointestinal bleeding is challenging due to broad coagulation abnormalities that are often not detected by standard coagulation tests. Viscoelastic hemostatic assays offer a real-time, point-of-care evaluation of the coagulation status.
Aims: To assess the hemostasis of liver disease patients with gastrointestinal bleeding and compare viscoelastic hemostasis tests results with standard coagulation parameters to explore the clinical value of viscoelastic assays.
Methods: In this retrospective study we investigated patients admitted to the emergency department for gastrointestinal bleeding who underwent both standard laboratory coagulation tests and viscoelastic hemostatic tests. Patients on anticoagulant therapy were excluded. The study compared coagulation parameters, analysed the correlations between viscoelastic and standard coagulation tests, and evaluated clinical outcomes, including mortality within 30 days, stratified by liver disease status.
Results: Of the 363 patients included, 107 (29%) had pre-existing liver disease. The international normalized ratio (INR) was significantly higher in patients with liver disease than in those without liver disease (1.47 vs 1.07; p < 0.001). The correlation between extrinsic pathway clotting time measured by viscoelastic test and INR showed a weak correlation in patients with liver disease (r = 0.49), whereas the correlation was stronger in patients without liver disease (r = 0.71). Among patients with an INR greater than 1.8 (n = 35), extrinsic pathway clotting time was less than 100 seconds in 77% of liver disease patients (17/22 subjects) and 46% of non-liver disease patients (6/14 subjects) (OR = 3.8; CI = 0.72-22.37; p = 0.079). Patients with liver disease received coagulation factor replacement more frequently, but their 30-day mortality rate was not significantly different from that of other patients.
Conclusions: Viscoelastic hemostatic assays provide a more detailed picture of the coagulation status of patients with gastrointestinal bleeding in liver disease and are expected to provide additional information compared to standard coagulation tests, particularly in supporting personalised therapeutic decisions. Further research is needed to confirm these results and to explore these tests influence on clinical outcomes.