Abstract Number: PB0416
Meeting: ISTH 2020 Congress
Background: Tissue factor pathway inhibitor (TFPI) is an intrinsic inhibitor of factor Xa. There is a paucity of data regarding the effect of TFPI in pediatric end stage liver disease (ESLD). TFPI is released from endothelium and metabolized by the liver and kidney, hence, plasma concentration of TFPI can potentially increase in liver failure.
Aims: Assessment of TFPI level in pediatric ESLD and potential role in bleeding risk.
Methods: In this pilot study, 13 pediatric ESLD patients included. Citrated plasma samples were analyzed for total TFPI via ELISA assay (Stago, USA). Corresponding prothrombin time (PT), activated partial thromboplastin time with hepzyme (HPTT), fibrinogen (FGN), platelet count (PLT) and ROTEM clotting time (CT) values were obtained from the electronic medical record. All data are expressed in mean±SD. Group means were compared by ANOVA (SPSS v25, IBM).
Results: Age 7.6±8 years, 77% female. Thirty-five samples were analyzed, 60% were collected at times corresponding with the bleeding episodes (Group I). Group I had higher TFPI (216±135 vs 108±33 ng/mL, p=0.006), but non-significant differences in PT (25±9 vs 31±11 sec, p=0.07), INR (2.3±1.0 vs 3.0±1.3, p=0.08), HPTT (49±19 vs 70±37 sec, p=0.05), FGN (165±53 vs 174±77 mg/dL, p= 0.70), EXTEM CT (75±12.5 vs 96±16 sec, p=0.05), INTEM CT(234±52 vs 300±57 sec, p=0.08), FIBTEM CT (13±5 vs 12±8 sec, p=0.85) and PLT (75±83 vs 68±56 ×103/µL, p=0.80) compared to the remaining 40% that did not correspond with the bleeding episodes (Group II). Overall mortality was 60%. Three patients with TPFI levels > 200 ng/mL (reference range 51.2-111.2 ng/ml) developed diffuse mucosal bleeding. One of them had additional heparinoid substance.
Conclusions: This is the first study to assess plasma TFPI level in pediatric ESLD. Plasma TFPI can be a clinically useful marker since it represents additional risk factor for bleeding that cannot be evaluated using routine testing.
To cite this abstract in AMA style:Navaei AH, Bruzdoski K, Kostousov V, Gokhale A, Hensch L, Hui S-R, Teruya J. Plasma Tissue Factor Pathway Inhibitor (TFPI) in Pediatric End Stage Liver Disease [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/plasma-tissue-factor-pathway-inhibitor-tfpi-in-pediatric-end-stage-liver-disease/. Accessed October 1, 2023.
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