From the Guidelines
Patients with liver cirrhosis should be monitored with platelet count, PT/aPTT, and fibrinogen levels.
Monitoring Parameters
- Platelet count: used as a marker of portal hypertension and sequestration, although it does not take into account the role of elevated VWF in compensating for thrombocytopenia 1
- PT/aPTT: easily accessible and a marker of liver disease severity, but only sensitive for procoagulant proteins and not suitable to assess hemostatic competency 1
- Fibrinogen: easily accessible, but unclear what levels are required for hemostasis in patients with liver disease, and does not take into account potential structural changes in the fibrin clot 1
Additional Tests
- Viscoelastic tests (VETs): such as thromboelastography (TEG) or rotational thromboelastometry (ROTEM), may be used to evaluate clotting in patients with cirrhosis, but currently lack validated target levels 1
- Global tests of clot formation: such as thrombin generation, may eventually have a role in the evaluation of clotting in patients with cirrhosis, but currently lack validated target levels 1
Limitations of Coagulation Testing
- Conventional laboratory tests: such as INR or platelet count, do not accurately predict bleeding risk in patients with cirrhosis 1
- Correction of abnormal laboratory tests: with blood products or factor concentrates is not recommended to prevent spontaneous bleeding in patients with cirrhosis 1
From the Research
Laboratory Tests for Liver Cirrhosis
The following laboratory tests are used to monitor patients with liver cirrhosis:
- Complete blood count (CBC) 2
- Comprehensive metabolic panel (CMP) 2
- Prothrombin time (PT) 2, 3
- Liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 3
- Serum alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) 3
- Serum albumin 3
- Indocyanine clearance tests (ICG-K) and methacetin breath test (MBT) for quantitative liver function assessment 3
- Model for end-stage liver disease (MELD) and Child-Turcotte Pugh score for assessing liver function 3, 4
Non-Invasive Tests
Non-invasive tests, such as:
- Elastography, a non-invasive assessment of liver stiffness measured in kilopascals, can typically confirm cirrhosis at levels of 15 kPa or greater 5
- Transient elastography 3
- MRI-based 99mTc-coupled asialoglycoprotein mebrofenin scan 3
- Ultrasound 6
Other Tests
Other tests, such as:
- Hepatic venous pressure gradient (HVPG) for assessing portal hypertension, although it is invasive and not available in all centers 3
- LiMAx test for evaluating actual liver function in patients with cirrhosis 4
- Liver biopsy, although it is invasive and may not be necessary for diagnosis in all cases 5