Q: Which provides a better measurement of coagulopathy in hepatic patients before an invasive procedure?

A) INR
B) PTT
C) TEG
D) Platelets 
E) Bleeding time


Answer:  C

 INR as a target to measure bleeding risk do not apply to patients with hepatic coagulopathy, as it has a completely different pathway of pathophysiology. Actually, assessment of global clot formation provides better approach like thromboelastography (TEG) (or rotational thromboelastometry - ROTEM). FFP may be required if the reaction time (r) is more than 40 minutes and platelets if the maximum amplitude (MA) is less than 30 mm. TEG and ROTEM in patients with hepatic coagulopathy decrease the use of blood product.


Reference:

De Pietri L, Bianchini M, Montalti R, et al. Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial. Hepatology 2016; 63:566.