Thromboelastography vs. conventional coagulation tests in decompensated liver disease: a comparative analysis

Introduction. Thromboelastography (TEG) is a dynamic assessment tool used to assess hemostasis with decompensated chronic liver disease (DCLD). Conventional coagulation tests, such as prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT), may not fully reflect the complexity of coagulation abnormalities in these patients. This study investigates the correlation between TEG parameters, conventional coagulation tests, and platelet count in patients with and without clinical bleeding manifestations. Material and methods. A cross-sectional study was conducted on patients diagnosed with DCLD. Data were collected on demographics, disease etiology, Child-Pugh classification, MELD-NA scores, conventional coagulation parameters, and TEG. The study evaluated the association of TEG variables with platelet count and standard coagulation markers, as well as their predictive value for bleeding risk. Results. Most patients had advanced liver disease, as indicated by Child-Pugh and MELD-NA scores. The most common etiology was alcohol-related liver disease, followed by viral hepatitis and non-alcoholic steatohepatitis (NASH). TEG parameters demonstrated significant correlations with conventional coagulation test: reaction time (R) was associated with INR (p = 0.004), clot kinetics (K) correlated with INR (p = 0.015) and aPTT (p = 0.009), and the angle parameter with aPTT (p = 0.025). Maximum amplitude (MA) had a strong correlation with platelet count and was significantly lower in patients with bleeding. Although platelet count alone did not predict bleeding risk, MA emerged as a reliable indicator of clot stability. Conclusion. TEG provides a more comprehensive evaluation of coagulation abnormalities in DCLD compared to conventional tests. These findings support the integration of TEG into routine clinical practice for improved assessment of bleeding risk and transfusion management in patients with liver disease. Further multicenter studies are warranted to validate these results and refine coagulopathy management in DCLD.