PB1052 - Evaluating the individual risk of venous thrombo-embolism in patients with liver cirrhosis: Usefulness of in vivo and ex vivo thrombin generation parameters

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Cindy Pereira Portela, MD Student

MD student
Division and Central Laboratory of Hematology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
Lausanne, Vaud, Switzerland

Co-Author(s)

MF

Montserrat Fraga

Associate physician
Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne
Lausanne, Vaud, Switzerland
MZ

Maxime Grégoire G. Zermatten

Physician assistant
Division and Central Laboratory of Hematology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
Lausanne, Vaud, Switzerland
Debora Bertaggia Calderara, PhD

Research Associate
Division and Central Laboratory of Hematology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
Lausanne, Vaud, Switzerland
Alessandro Aliotta, PhD

Research Associate
Division and Central Laboratory of Hematology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
Lausanne, Vaud, Switzerland
�M

Élise Mdawar-Bailly

Study nurse
Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne
Lausanne, Vaud, Switzerland
FA

Florent Artru

PhD-student
Institute of Liver Studies, King’s College Hospital
London, England, United Kingdom
DM

Darius Moradpour

Physician in Chief, Full Professor
Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne
Lausanne, Vaud, Switzerland
LA

Lorenzo Alberio, MD (he/him/his)

Chief Physician, Associated Professor
Division and Central Laboratory of Hematology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
Lausanne, Vaud, Switzerland

Background: Venous thrombo-embolic events (VTE) and especially splanchnic vein thromboses (SVT) are common complications in patients with liver cirrhosis. SVT can worsen portal hypertension and cause ascitic decompensation. Identification of high-risk patients and consecutive targeted primary prophylactic anticoagulation could prevent these complications, preserving favorable conditions for liver transplantation as well as improving patient quality of life and prognosis.

Aims: To investigate the role of in vivo and ex vivo thrombin generation (TG) parameters in the prediction of VTE in patients with liver cirrhosis.

Methods: We performed a prospective single-centre study at Lausanne University Hospital (CHUV) including 294 non-anticoagulated patients with liver cirrhosis. The outcome was VTE including deep venous thrombosis, pulmonary embolism and SVT. We analysed in vivo TG-parameters (prothrombin fragments 1 and 2 [F1+2], thrombin-antithrombin complexes [TAT], D-dimers) and ex vivo TG measured using the ST Genesia Thrombin Generation System (Stago, Asnières-sur-Seine, France) with an intermediate concentration of tissue factor, without and with thrombomodulin (TM). Comparisons between groups were assessed by Mann-Whitney test.

Results: Median age was 59 years (range, 18-81 years) and 68 patients (23%) were female. Regarding cirrhosis severity, 235 (79.9%) had a Child-Pugh score A, 49 (16.7%) B and 10 (3.4%) C. Comparisons between groups with and without VTE are presented in Table 1. The velocity index, TM-mediated inhibition, TAT, F1+2 and D-dimers as well as aPTT and PT were significantly associated with the VTE risk.

Conclusion(s): In vivo and ex vivo TG-parameters are associated with VTE risk in patients with liver cirrhosis. The integration of these parameters with clinical (e.g. liver cirrhosis etiology, history of VTE, or cancer) and paraclinical variables (in particular, hemodynamic parameters such as portal vein flow) is a promising approach to identify high-risk patients who could benefit from primary prophylactic anticoagulation. Analyses are ongoing to develop a VTE risk prediction score in patients with liver cirrhosis.