- Email: [email protected]
937 ROTATIONAL THROMBOELASTOMETRY IN CIRRHOSIS: THE CLOT THICKENS!
POSTERS significantly higher in non-AT PVT vs non-PVT patients (48.6% vs 21.1%, p ≤ 0.001) and better in AT PVT vs non-AT PVT (13.6% vs 48.6%, p = 0.01). Conclusions: PVT worsens the prognosis of patients with previous variceal haemorrhage. Rebleeding is not affected if adequate prophylaxis is performed. AT achieves PTV re-permeation and seems to ameliorate the outcome of these patients. 937 ROTATIONAL THROMBOELASTOMETRY IN CIRRHOSIS: THE CLOT THICKENS! V. Jairath1,2 , S. Stanworth3 , N. Curry3 , A. Raja2 , J. Collier4 , P. Harrison5 , M. Murphy3 , E. Barnes6 . 1 Department of Gastroenterology, NHS Blood and Transplant and John Radcliffe Hospital, 2 NHS Blood and Transplant, 3 Transfusion Medicine, NHS Blood and Transplant and John Radcliffe Hospital, 4 Department of Hepatology, John Radcliffe Hospital, 5 Oxford Haemophilia and Thrombosis Centre, 6 Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, Oxford, UK E-mail: [email protected] Background: Cirrhotics have complex derangements of haemostasis. Routine plasma based coagulation tests suggest a hypocoaguable profile, resulting in frequent administration of blood components for prophylaxis and treatment of bleeding complications. Rotational thromboelastography (ROTEM® ), unlike standard coagulation tests, measures clot formation, strength and stability in whole blood and thus may more accurately reflect in vivo coagulation and guide rational transfusion. Aims and methods: 1) To compare parameters of clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) in stable, non-bleeding cirrhotics to healthy volunteers; 2) To assess the correlation between thromboelastometry profiles in cirrhotics and routine coagulation tests. ROTEM® was performed on citrated whole blood from cirrhotics attending out-patients and healthy volunteers. Clot activation was stimulated using the INTEM test (ellagic acid to activate the intrinsic coagulation pathway), EXTEM test (tissue factor to trigger the extrinsic pathway) and FIBTEM test (to determine contribution of fibrinogen to clot). Results: 42 adult patients with cirrhosis and 28 healthy volunteers were enrolled. Aetiology: Alcoholic 23/42 (55%), HCV 9/42 (21%), autoimmune 3/42 (7%), cryptogenic 2/42 (5%), HBV 2/42 (5%), haemochromatosis 2/42 (5%), NAFLD 1/42 (2%). The median EXTEM CT was significantly shorter in cirrhotics than controls (51s vs. 57s, p < 0.01). The median EXTEM CT clotting time shortened as Child’s score increased (52s Child A, 49s, Child B, 47s Child C). There was no significant difference in the median EXTEM CFT (95s vs. 77s, p = 0.19) or EXTEM MCF (61s vs. 63s, p = 0.28) between cirrhotics and controls. There was no significant difference in the median EXTEM MCF according to the severity of Child score (A=61s, B=61s, C=54s, p > 0.4 for all comparisons). Similar results were seen with INTEM and FIBTEM parameters. In cirrhotics there was strong correlation between platelet count and EXTEM MCF (r = 0.771, p < 0.0001), and between fibrinogen and FIBTEM MCF (r= 0.777, p < 0.0001). Conclusions: ROTEM analysis demonstrated hypercoagulability in cirrhotics, despite prolonged PT, APTT and thrombocytopenia. This data supports the concept of balanced haemostasis, not reflected by routine plasma based coagulation tests. Further validation of ROTEM® may avoid unnecessary and potentially harmful transfusion of blood components in patients with cirrhosis.
938 ARGON PLASMA COAGULATION IS AN EFFECTIVE TREATMENT IN CIRRHOSIS-RELATED GASTRIC ANTRAL VASCULAR ECTASIAS C. Krystallis, P.C. Hayes, J.N. Plevris. Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK E-mail: [email protected] Introduction: Gastric antral vascular ectasias (GAVE) represent an uncommon cause of upper GI bleeding (UGIB). There is an association with liver cirrhosis and portal hypertension in 30% of the patients, and account for 4% of non-variceal UGIB. GAVE and severe portal hypertensive gastropathy (PHG) are distinctive entities. Treatments aiming to lower portal pressure are usually ineffective to treat cirrhosis-related GAVE. Although thermal ablation techniques are effective in non-cirrhotic GAVE, there is limited data on the value of Argon plasma coagulation (APC) in the treatment of cirrhosis-related GAVE. Aim: To evaluate the efficacy and safety of APC treatment in cirrhotic patients with UGIB due to GAVE. Methods: Cirrhotic patients were retrospectively included in our study over a 10-year period, if they presented with overt or occult bleeding related to GAVE and treated with APC. Success was defined as; control of bleeding, stabilisation of Hb over 100 g/dl, or Hb increase >10% from pre-treatment level, and reduction of transfusion requirements >50% in transfusion-dependent patients. Results: Twenty cirrhotic patients with GAVE (Group A) treated with APC, (flow 2 L/min, power 45–65 W) were identified and compared with a randomly selected group of 10 non-cirrhotic GAVE patients (Group B). Overall patients’ demographics were; M/F 17/13, mean age 71.13 years. The two groups presented with overt bleeding (60% vs 40%), occult bleeding (40% vs 60%) whereas transfusion was required in (60% vs 80%) in group A and B respectively. Overall endoscopic treatment with APC was successful in 86.6% (85% vs 90% NS) in Groups A and B respectively. The mean number of APC sessions required between the two groups (A vs B) was 3.88 vs 3.5 (NS) median: 2 vs 2. No adverse effects from APC therapy were recorded in any of the patients despite the presence of significant coagulopathy in the majority of the cirrhotic patients. Conclusion: APC proved effective and safe in the treatment of cirrhosis-related GAVE UGIB. Treatment success was not compromised by disease severity or coagulation status. Our data suggests that APC should be considered as the treatment of choice in cirrhosis-related GAVE. 939 CORRELATION OF TRANSIENT ELASTOGRAPHY (TE) WITH HEPATIC VENOUS PRESSURE GRADIENT (HVPG): A PROSPECTIVE STUDY A. Kumar1,2 , P. Sharma1 , M. Kumar1 , H. Garg1 , S.K. Sarin1,2 . 1 Hepatology, Institute of Liver and Biliiary Sciences, 2 Special Centre for Molecular Medicine, Jawaharlal Nehru University (JNU), New Delhi, India E-mail: [email protected] Background: Hepatic venous pressure gradient (HVPG) is a prognostic marker in patients with cirrhosis. Complications of cirrhosis generally parallel with increase in HVPG. Because HVPG is expensive and invasive, a non-invasive marker to measure portal hypertension would be useful. Transient elastography (TE) is a good non-invasive estimator of hepatic fibrosis. Whether TE could be used as non-invasive tool to measure portal hypertension has not been studied. Aim: To assess the correlation between TE and HVPG and to investigate the performance of TE for the prediction of various complications of portal hypertension. Patients and Methods: TE was prospectively measured in consecutive patients of cirrhosis undergoing HVPG for evaluation
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938 ARGON PLASMA COAGULATION IS AN EFFECTIVE TREATMENT IN CIRRHOSIS-RELATED GASTRIC ANTRAL VASCULAR ECTASIAS C. Krystallis, P.C. Hayes, J.N. Plevris. Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK E-mail: [email protected] Introduction: Gastric antral vascular ectasias (GAVE) represent an uncommon cause of upper GI bleeding (UGIB). There is an association with liver cirrhosis and portal hypertension in 30% of the patients, and account for 4% of non-variceal UGIB. GAVE and severe portal hypertensive gastropathy (PHG) are distinctive entities. Treatments aiming to lower portal pressure are usually ineffective to treat cirrhosis-related GAVE. Although thermal ablation techniques are effective in non-cirrhotic GAVE, there is limited data on the value of Argon plasma coagulation (APC) in the treatment of cirrhosis-related GAVE. Aim: To evaluate the efficacy and safety of APC treatment in cirrhotic patients with UGIB due to GAVE. Methods: Cirrhotic patients were retrospectively included in our study over a 10-year period, if they presented with overt or occult bleeding related to GAVE and treated with APC. Success was defined as; control of bleeding, stabilisation of Hb over 100 g/dl, or Hb increase >10% from pre-treatment level, and reduction of transfusion requirements >50% in transfusion-dependent patients. Results: Twenty cirrhotic patients with GAVE (Group A) treated with APC, (flow 2 L/min, power 45–65 W) were identified and compared with a randomly selected group of 10 non-cirrhotic GAVE patients (Group B). Overall patients’ demographics were; M/F 17/13, mean age 71.13 years. The two groups presented with overt bleeding (60% vs 40%), occult bleeding (40% vs 60%) whereas transfusion was required in (60% vs 80%) in group A and B respectively. Overall endoscopic treatment with APC was successful in 86.6% (85% vs 90% NS) in Groups A and B respectively. The mean number of APC sessions required between the two groups (A vs B) was 3.88 vs 3.5 (NS) median: 2 vs 2. No adverse effects from APC therapy were recorded in any of the patients despite the presence of significant coagulopathy in the majority of the cirrhotic patients. Conclusion: APC proved effective and safe in the treatment of cirrhosis-related GAVE UGIB. Treatment success was not compromised by disease severity or coagulation status. Our data suggests that APC should be considered as the treatment of choice in cirrhosis-related GAVE. 939 CORRELATION OF TRANSIENT ELASTOGRAPHY (TE) WITH HEPATIC VENOUS PRESSURE GRADIENT (HVPG): A PROSPECTIVE STUDY A. Kumar1,2 , P. Sharma1 , M. Kumar1 , H. Garg1 , S.K. Sarin1,2 . 1 Hepatology, Institute of Liver and Biliiary Sciences, 2 Special Centre for Molecular Medicine, Jawaharlal Nehru University (JNU), New Delhi, India E-mail: [email protected] Background: Hepatic venous pressure gradient (HVPG) is a prognostic marker in patients with cirrhosis. Complications of cirrhosis generally parallel with increase in HVPG. Because HVPG is expensive and invasive, a non-invasive marker to measure portal hypertension would be useful. Transient elastography (TE) is a good non-invasive estimator of hepatic fibrosis. Whether TE could be used as non-invasive tool to measure portal hypertension has not been studied. Aim: To assess the correlation between TE and HVPG and to investigate the performance of TE for the prediction of various complications of portal hypertension. Patients and Methods: TE was prospectively measured in consecutive patients of cirrhosis undergoing HVPG for evaluation
Journal of Hepatology 2011 vol. 54 | S363–S534
S375