Magnesium therapy improves thromboelastographic finding in end-stage liver patients

ABSTRACT

Patients with end stage liver disease are predisposed to hypomagnesemia which may cause bleeding tendency. There are many evidences suggesting that magnesium is a crucial constituent of the blood coagulation cascade and has a pro-coagulant activity. The aim of the study was to assess the effect of magnesium therapy on thromboelastography [TEG] in patients with end stage liver disease. The study was conducted on thirty patients with end stage liver disease in the intensive care unit. Four grams of magnesium sulfate, diluted in normal saline, were infused to all patients. The TEG findings immediately before and 15 minutes after the magnesium infusion were compared. The TEG findings showed general hypocoagulability before magnesium therapy. The R time and K time were shortened significantly from 1090.7 +/- 376.3 [mean +/- SD] to 870 +/- 211.9 sec and from 659.3 +/- 321.6 to 449.3 +/- 319.6 sec respectively [p<0.05]; the Alpha angle and maximal amplitude showed significant increases from 28.1 +/- 11.3 to 373 +/- 12.6 and from 37.8 +/- 11.4 to 46.6 +/- 13.1 mm respectively after magnesium therapy [p<0.05]. Also, serum magnesium level rises significantly from 1.9 to 3.1 mg. dl-1 [p<0.05]. In conclusion, magnesium therapy improved the overall TEG findings in patients with end stage liver disease who show signs of TEG hypocoagulability and hypomagnesaemia. Further studies will be needed to investigate the effect of magnesium therapy and the improvement of TEG variables on clinical outcome of patients