Haemostasis in acutely ill patients with advanced liver disease
Research type
Research Study
Full title
Multi-centre, prospective observational cohort study of haemostasis in acutely ill patients with advanced chronic liver disease
IRAS ID
323059
Contact name
Lara Roberts
Contact email
Sponsor organisation
King's College Hospital
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
The liver plays a key role in producing the proteins involved in blood clotting (haemostasis), both proteins promoting clotting (pro-coagulants) and those preventing clotting (anti-coagulants). It also has a role in removing these proteins from the circulation. Patients with liver disease have complex changes in haemostasis, which is overall ‘rebalanced’. When patients with liver disease are sick, and admitted to hospital, this rebalanced haemostasis is thought to be more unstable. These patients are at high risk of both bleeding and blood clots (thrombosis). Standard laboratory tests of haemostasis only measure the pro-coagulant part of the clotting process and are often interpreted as indicating an increased risk of bleeding. As a result, these patients often receive transfusions of clotting proteins. There is new evidence to suggest these transfusions may not improve blood clotting in patients with liver disease, and concern that these transfusions may be harmful. There is therefore an urgent need to identify better laboratory tests to measure blood clotting in this patient group to reduce the use of transfusions (when not needed), and to work out which patients are at risk of bleeding and/or thrombosis.
This study will look at whether novel blood tests (thromboelastography, thrombin generation, clot lysis assays and neutrophil extracellular traps) can better measure haemostasis in patients with liver disease admitted to hospital, and thereby reduce the use of transfusion. It will also look at whether haemostasis in these patients remains stable over time, the effect of transfusion on haemostasis and whether we can predict which patients are at risk of bleeding or thrombosis. Participants will be recruited from 5 hospitals in England over two years. Blood samples will be taken on admission, 24 hours and 5 days later with monitoring for bleeding/thrombosis for up to 4 weeks after admission.REC name
Wales REC 1
REC reference
23/WA/0174
Date of REC Opinion
23 Jun 2023
REC opinion
Further Information Favourable Opinion