TANIA RUBIA FLORES DA ROCHA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Assunto: Cirrhosis ×

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  • article 0 Citação(ões) na Scopus
    Preservation of platelet function in patients with cirrhosis and thrombocytopenia undergoing esophageal variceal ligation
    (2020) SOUZA, Evandro de Oliveira; D'AMICO, Elbio Antonio; ROCHA, Tania Rubia Flores da; FERREIRA, Caroline Marcondes; BATISTA, Juliana Medeiros; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair Jose; FARIAS, Alberto Queiroz
    Background: Thrombocytopenia is a possible risk factor for bleeding after band ligation of esophageal varices. However, elevated von Willebrand factor (VWF) in cirrhosis improves platelet function and could decrease this risk. Our objective was to assess platelet function in patients with cirrhosis undergoing esophageal variceal ligation (EVL). Methods: The assessment consisted of platelet count, antigen and activity of VWF and VWF-cleaving protease ADAMTS-13 activity, and a platelet adhesion and aggregation test simulating vascular flow in vivo (Impact-R (R)) prior to EVL. Results: Totally 111 patients were divided into three groups according to platelet count: (1) < 50 x 10(9)/L (n = 38, 34.2%); (2) 50 x 10(9)/L to 100 x 10(9)/L (n = 47, 42.3%); and (3) > 100 x 10(9) /L (n = 26, 23.4%). No statistically significant difference was found in the aggregate size of platelets [group 1: 41.0 (31.8-67.3) mu m(2); group 2: 47.0 (33.8-71.3) mu m(2); and group 3: 47.0 (34.0-66.0) mu m(2); P = 0.60] and no significant correlation was found between aggregate size and platelet count (Spearman r = 0.07; P = 0.47). Surface coverage was 4.1% (2.8%-6.7%), 8.5% (4.0%-10.0%), and 9.0% (7.1%-12.0%) (P < 0.001) in groups 1, 2 and 3, respectively and correlated with platelet count (Spearman r = 0.39; P < 0.0001). There was no significant difference between groups in VWF or ADAMTS-13. Post-EVL bleeding occurred in six (5.4%) patients (n = 2 in group 1, n = 1 in group 2, and n = 3 in group 3; P = 0.32). Patients with bleeding had higher MELD scores [15.0 (11.3-20.3) versus 12.0 (10.0-15.0); P = 0.025], but no difference was demonstrated for platelet function parameters. Conclusion: Platelet function is preserved even in the presence of thrombocytopenia, including in the patients with post-EVL bleeding.
  • article 65 Citação(ões) na Scopus
    Fresh frozen plasma transfusion in patients with cirrhosis and coagulopathy: Effect on conventional coagulation tests and thrombomodulin-modified thrombin generation
    (2020) RASSI, Amanda Bruder; D'AMICO, Elbio Antonio; TRIPODI, Armando; ROCHA, Tania Rubia Flores da; MIGITA, Beatriz Yuri; FERREIRA, Caroline Marcondes; CARRILHO, Flair Jose; FARIAS, Alberto Queiroz
    Background & Aims: The efficacy of fresh frozen plasma (FFP) transfusion in enhancing thrombin generation in patients with cirrhosis and impaired conventional coagulation tests has not been sufficiently explored. Thus, we aimed to assess the effect of FFP transfusion on thrombin generation in these patients. Methods: Fifty-three consecutive patients receiving a standard dose of FFP to treat bleeding and/or before invasive procedures - if international normalized ratio (INR)/prothrombin time (PT) ratio were >= 1.5 - were prospectively enrolled. The primary endpoint was the amelioration of endogenous thrombin potential (ETP) with thrombomodulin (ETP-TM) after transfusion, which corresponds to the total amount of generated thrombin. INR/PT ratio and activated partial thromboplastin time (aPTT) were also assessed before and after transfusion. Results: FFP enhanced ETP-TM by 5.7%, from 973 (731-1,258) to 1,028 (885-1,343 nM x min; p = 0.019). Before transfusion, evidence of normal or high ETP-TM was found in 94% of patients, even in those with bacterial infections. Only 1 (1.9%) patient had ETP-TM values reverting to the normal range after transfusion. Notably, no patients with low ETP-TM had bleeding. The median decrease in ETP-TM was 8.3% and the mean was 12.8% in 18 (34%) patients after transfusion (from 1,225 [1,071-1,537] to 1,124 [812-1,370] nM x min; p <= 0.0001). Similar responses to FFP transfusion were observed in patients with compensated and acute decompensated cirrhosis, acute-on-chronic liver failure, infection or shock. FFP significantly ameliorated INR and aPTT values (p <0.0001), but in a minority of patients the values were reduced to less than the cut-off point of 1.5. Conclusions: FFP transfusion enhanced thrombin generation and ameliorated conventional coagulation tests to normal values in a limited number of patients, and slightly decreased thrombin generation in 34% of cases. Lay summary: Transfusion of fresh frozen plasma in patients with cirrhosis only slightly improves coagulation test values in a limited number of patients and even appears to worsen them in a third of cases. Transfusion for the purpose of preventing or treating bleeding events could cause inherent risks and costs without clear benefits. (C) 2019 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.