Correlação entre os testes convencionais da coagulação e tromboelastometria na avaliação da hemostasia na cirrose avançada em pacientes ambulatoriais

Abstract

To study the correlation between conventional coagulation tests (INR, PTTa, platelets and fibrinogen) and thromboelastometry. Ambulatory patients with Child Pugh B and C cirrhosis were assessed by thromboelastometry and conventional coagulation tests at the same time. The parameters evaluated in the thromboelastometry were: clotting time (CT); amplitude 10min after CT (A10); clot formation time (CFT) and maximum clotting formation (MCF), all of which were performed in the INTEM, EXTEM and FIBTEM phases. Sixty-two patients were evaluated (mean age: 60 (± 10) years, 58% men), 79% (49) Child Pugh B, and the median Meld were 14 ± 3. There was no statistical correlation between the CT of the EXTEM and INR. Serum fibrinogen dosage showed a correlation with the following thromboelastometric parameters: INTEM A10 (r = 0.344, p = 0.01), CFT (r = -0.277, p <0.043), and INTEM MCF (r = 0.304; = 0.024). The conventional test that was best associated with thromboelastometry was the platelet count: A10 of the INTEM (r = 0.799; p <0.001); A10 of EXTEM (r = 0.746, p <0.001); (R = -0.774, p <0.001), INTEM MCF (r = 0.740, p <0.001), and EXTEM MCF (r = 0.725; p = 0.725; p <0.001) <0.001). The platelet cutoff for the identification of platelet deficiency in thromboelastometry was 87,000 cells /mm, with an area under the curve of 0,88 (p <0.001). Conventional coagulation tests, especially those that specifically assess coagulation factors, do not show a good correlation with coagulation assessed by thromboelastometry. However, among the conventional tests, the platelet count showed good correlation with thromboelastometry. These data should be considered in order to guide transfusion therapy in outpatients with advanced cirrhosis, in the presence of bleeding and in the absence of global exams, such as thromboelastometry.