The Predictive Value of the Rotational Thromboelastometry for Bleeding Risk in Patients With Child-Pugh Class C Cirrhosis.

ObjectivePatients with cirrhosis are in a fragile state of rebalanced hemostasis and are at risk of bleeding and thrombotic complications. Conventional coagulation tests such as PT, APTT, and fibrinogen often fail to accurately predict bleeding risk in patients with advanced cirrhosis. We aimed to investigate the role of Rotational Thromboelastometry (ROTEM) in predicting bleeding risk due to coagulopathy in patients with decompensated cirrhosis.MethodsWe carried out a retrospective analysis of patients diagnosed with Child-Pugh class C cirrhosis. We conducted ROTEM tests on each patient and observed the results to record any instances of bleeding. To explore the relationship with bleeding incidents, we performed both univariate and multivariate logistic regression analyses.ResultsAmong the 124 patients diagnosed with Child-Pugh C cirrhosis, most were between 40 and 61 years of age. Overall, 59.7% of patients did not experience bleeding events. All ROTEM parameters (INTEM, EXTEM and FIBTEM) associated with clot amplitude, such as A5 and maximum clot firmness (MCF), showed significant differences between patients who experienced bleeding and those who did not (p < 0.05), whereas the clotting time parameters remained unchanged. Multivariate logistic regression analysis revealed that an MCF EXTEM greater than 45 mm was independently associated with a lower risk of bleeding.ConclusionROTEM parameters that indicate clot firmness, especially MCF EXTEM, are associated with bleeding risk in patients with Child-Pugh class C cirrhosis. Viscoelastic testing can be useful in identifying patients with a low bleeding risk and offers a more thorough evaluation of hemostasis than traditional coagulation tests.