{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T07:58:22Z","timestamp":1789286302960,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T00:00:00Z","timestamp":1627776000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Patients with acute liver injury or failure (ALI\/ALF) experience bleeding complications uncommonly despite an abnormal hemostatic profile. Rotational thromboelastometry (ROTEM), which assesses clot formation in whole blood, was used to determine the nature of abnormal hemostasis and whether it contributes to bleeding events, illness severity, or survival.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>A total of 200 patients were recruited from sites of the ALF Study Group. Blood collected daily for up to 5\u00a0days was analyzed using ROTEM delta devices. Consistent with standard laboratory evidence of hypocoagulability (median international normalized ratio = 2.9 and platelet count = 144\u00a0\u00d7\u00a010<jats:sup>9<\/jats:sup>\/L), patients frequently exhibited ROTEM parameters outside the normal range (73% and 62% had abnormalities in clot formation from extrinsic and intrinsic clotting cascades, respectively); however, measures of clot stability were generally normal. Eighteen patients (9%) experienced bleeding events, in whom clot initiation, assembly, and firmness were more severely deranged than patients without bleeding. Abnormal ROTEM parameters were more frequently observed in patients with non\u2010acetaminophen ALI\/ALF than those with acetaminophen ALI\/ALF (clot initiation [<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001], assembly [<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.02], firmness at 10\u00a0minutes [<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.05], and maximal firmness [<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.06]). Patients with more severe systemic complications (high\u2010grade hepatic encephalopathy and need for renal replacement therapy) also had a higher incidence of abnormal ROTEM parameters. Finally, more hypocoagulable ROTEM parameters (clot initiation (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.005), stiffness at 10\u00a0minutes (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.05), and maximal stiffness by fibrin assembly (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.004)) were observed in patients who died or underwent liver transplantation than those who survived with their native liver.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In patients with ALI\/ALF, abnormal ROTEM parameters are frequent and proportional to disease severity. Whether the increased bleeding risk associated with abnormal ROTEM indicates hemostatic failure or is a proxy for disease severity requires additional study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31767","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T12:17:47Z","timestamp":1614341867000},"page":"937-949","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":49,"title":["Coagulopathy, Bleeding Events, and Outcome According to Rotational Thromboelastometry in Patients With Acute Liver Injury\/Failure"],"prefix":"10.1097","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9901-854X","authenticated-orcid":false,"given":"R. Todd","family":"Stravitz","sequence":"first","affiliation":[{"name":"Hume\u2010Lee Transplant Center of Virginia Commonwealth University,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Fontana","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Michigan,Ann Arbor,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlyn","family":"Meinzer","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences,Medical University of South Carolina,Charleston,SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Durkalski\u2010Mauldin","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences,Medical University of South Carolina,Charleston,SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. James","family":"Hanje","sequence":"additional","affiliation":[{"name":"Department of Medicine,The Ohio State University,Columbus,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2818-4959","authenticated-orcid":false,"given":"Jody","family":"Olson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology,University of Kansas Medical Center,Kansas City,KS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Medicine,Medical University of South Carolina,Charleston,SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Hamid","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of California at San Francisco,San Francisco,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Schilsky","sequence":"additional","affiliation":[{"name":"Divisions of Digestive Disease and Transplant and Immunology,Yale University,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"McGuire","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology,University of Alabama,Birmingham,AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ganger","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology,Northwestern University,Chicago,IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Liou","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Washington,Seattle,WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1555-1089","authenticated-orcid":false,"given":"Constantine J.","family":"Karvellas","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology (Liver Unit) and Department of Critical Care Medicine,University of Alberta,Edmonton,AB,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jody A.","family":"Rule","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,University of Texas, Southwestern Medical Center,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3503-7140","authenticated-orcid":false,"given":"Ton","family":"Lisman","sequence":"additional","affiliation":[{"name":"Department of Surgery,University of Groningen,Groningen,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Clasen","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences,Medical University of South 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