Thrombin generation in cirrhotic patients pre and post fresh frozen plasma transfusion

• Grant number: 15/00883-5
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2015
• End date: October 31, 2017
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Elbio Antonio D'Amico
• Grantee: Elbio Antonio D'Amico
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Alberto Queiroz Farias ; Amanda Bruder Rassi ; Claudia Alves Couto ; Liliana Sampaio Costa Mendes

Abstract

Routine coagulation tests, such as PT and aPTT, are frequently abnormal in patients with chronic liver disease, but they usually fail to predict bleeding risk, leading to a liberal transfusional policy for prophylaxis, particularly before invasive procedures. Previous in vitro studies (none in vivo so far) have shown that prophylactic transfusion of fresh frozen plasma (FFP) in patients with chronic liver disease and abnormal conventional coagulation tests has limited efficacy and did not increase thrombin generation, calling into question the common use of this policy. We formulate the hypothesis that FFP transfusion in patients with cirrhosis, in spite of being capable of slightly improving PT and PTTa, would not be significant effect on thrombin generation. Therefore, it would be unnecessary previously to invasive procedures, implying in additional risks to patients and increasing costs. Purposes: 1) To evaluate the impact of FFP transfusion on thrombin generation; 2) Define the accuracy of coagulations tests PT, PTTa and thrombin generation potential as predictors of bleeding related to invasive procedures. Methods: blood samples of 40 consecutive cirrhotic patients will be collected, before and after transfusion of FFP and send immediately to testing for PT, PTT and thrombine generation (with and without addiction of thrombomodulin). The primary outcome will be a difference of at least 10% in the ratio trombone generation performed in the presence/absence of thrombomodulin, when compared to baseline values. ROC curves will be used to determine sensibility, specificity, predictive values and positive and negative likelihood ratio of conventional and expand coagulation tests in predicting bleeding after invasive procedures. Adverse events (TRALI, TACO, hemolytic and other reactions) will be recorded. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

RASSI, AMANDA BRUDER; D'AMICO, ELBIO ANTONIO; TRIPODI, ARMANDO; FLORES DA ROCHA, TANIA RUBIA; MIGITA, BEATRIZ YURI; FERREIRA, CAROLINE MARCONDES; CARRILHO, FLAIR JOSE; FARIAS, ALBERTO QUEIROZ. Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation. JOURNAL OF HEPATOLOGY, v. 72, n. 1, p. 85-94, JAN 2020. (15/00883-5)