Rotational thromboelastometry can detect factor <scp>XIII</scp> deficiency and bleeding diathesis in patients with cirrhosis

Abstract

Abstract Background &amp; Aims Patients with progressive liver disease exhibit complex coagulation disorders. Factor XIII plays a crucial role in the last steps of haemostasis, and its deficiency is associated with an increased incidence of bleeding diathesis. However, current conventional coagulation tests cannot detect factor XIII deficiency. In this study, we examined factor XIII activity and the ability of rotational thromboelastometry to detect factor XIII deficiency and bleeding diathesis in patients with cirrhosis. Methods We retrospectively studied 74 patients with cirrhosis, comparing the results of conventional coagulation tests (international normalized ratio, activated partial thromboplastin time, platelet count, fibrinogen level), rotational thromboelastometry, factor XIII activity and clinical scores. Results Patients with cirrhosis exhibited reduced factor XIII activity. Factor XIII activity was positively correlated with conventional coagulation parameters and rotational thromboelastometry values, such as maximum clot formation ( MCF ) extem ( r =.48, P &lt;.0001) and MCF fibtem ( r =.60, P &lt;.0001). However, maximum lysis ( ML ) extem and ML aptem were not correlated with factor XIII activity. Three‐month mortality rates ( P =.0469) and bleeding complications ( P &lt;.0001) were significantly associated with lower factor XIII activity. Patients with haemorrhage exhibited significantly altered rotational thromboelastometry values. Conclusions Reduced levels of MCF extem and MCF fibtem but not high levels of ML extem and ML aptem are associated with factor XIII deficiency in patients with liver disease. Therefore, substituting factor XIII should be considered for such patients to strengthen clot formation in patients experiencing haemorrhage or those who have undergone interventions.