THROMBELASTOGRAPHIC CHANGES AND EARLY REBLEEDING IN CIRRHOTIC-PATIENTS WITH VARICEAL BLEEDING

Background-Routine coagulation tests do not necessarily reflect haemos tasis in vivo in cirrhotic patients, particularly those who have bleed ing varices. Thrombelastography (TEG) can provide a global assessment of haemostatic function from initial clot formation to clot dissolutio n. Aim-To evaluate TEG changes in cirrhotic patients with variceal ble eding and their association with early rebleeding. Patients/Methods-Tw enty cirrhotic patients with active variceal bleeding had serial TEG a nd routine coagulation tests daily for seven days. The TEG variables b efore the day of rebleeding (n = 6) were compared with those of patien ts without rebleeding (n = 14). Results-Baseline characteristics reble eding and non-rebleeding groups were comparable apart from a higher in cidence of uncontrolled infection on the day of rebleeding in the rebl eeding group (p = 0.007). The patients in the rebleeding group were mo re hypocoagulable before the day of rebleeding as shown by longer r (4 2 v 24 mm, p<0.001) and k (48 v 13 mm, p<0.001) and smaller a (12 v 38 degrees, p<0.001) compared with the mean of daily results of the non- rebleeding group. Routine coagulation tests, however, showed no signif icant differences between the two groups. Conclusion-The results of se rial TEG measurements suggest that hypocoagulability may be associated with early rebleeding in cirrhotic patients.