Abstract: Objective To investigate the changes of coagulation function in patients with acute-on-chronic liver failure (ACLF) and thrombocytopenia. Methods One hundred and forty-five cases of patients with ACLF and thrombocytopenia were divided into 4 groups, including group A (39 cases with the platelet numbers ≥ 100×10⁹/L), group B (41 cases with the platelet numbers between [50-99]×10⁹/L), group C (34 cases with the platelet numbers between [30-49]×10⁹/L) and group D (31 cases with the platelet numbers ≤ 29×10⁹/L). The coagulation function was evaluated using thromboelastography (TEG) and routine coagulation tests, and compared among the groups. Results Compared with patients of ACLF with platelet number ≥ 100×10⁹/L, prothrombin time activity (PTA) were significantly lower, and international normalized ratio (INR) were significantly higher in patients with platelet number < 100×10⁹/L, the difference was statistically significant (P<0.05). The levels of PTA and INR were 31.80 ± 7.02 and 2.43 ± 0.61 in group A, 27.44 ± 10.15 and 2.79 ± 0.92 in group B, 27.85 ± 9.33 and 2.69 ± 0.72 in group C, 25.25 ± 6.50 and 3.05 ± 1.46 in group D, respectively. Compared with group A, group B and C had no significant difference in levels of prothrombin time and activated partial thromboplastin time, yet group D had significant difference. In the TEG, there were significant differences in the reaction time, speed of clot formation (k), α angle, maximal amplitude (MA) and coagulation index (CI) between group A and D (P<0.05), significant differences in values of k, α angle, MA and CI between group A and C (P<0.05), and significant differences in value of CI between group A and B (P<0.05). Conclusion The coagulation function of ACLF patients is prone to abnormality. The TEG can evaluate the coagulation function and fibrinolysis status of patients well, which is important for diagnosis and treatment of coagulation disorder in patients.

Key words: Acute-on-chronic liver failure, Thrombelastography, Routine coagulation tests