Sonoclot Signature Analysis in Patients with Liver Disease and Its Correlation with Conventional Coagulation Studies

Abstract

Introduction. Liver disease patients have complex hemostatic defects leading to a delicate, unstable balance between bleeding and thrombosis. Conventional tests such as PT and APTT are unable to depict these defects completely. Aims. This study aimed at analyzing the abnormal effects of liver disease on sonoclot signature by using sonoclot analyzer (which depicts the entire hemostatic pathway) and assessing the correlations between sonoclot variables and conventional coagulation tests. Material and Methods. Clinical and laboratory data from fifty inpatients of four subgroups of liver disease, including decompensated cirrhosis, chronic hepatitis, cirrhosis with HCC and acute-on-chronic liver failure were analyzed. All patients and controls were subjected to sonoclot analysis and correlated with routine coagulation parameters including platelet count, PT, APTT, fibrinogen, and D-dimer. Results. The sonoclot signatures demonstrated statistically significant abnormalities in patients with liver disease as compared to healthy controls. PT and APTT correlated positively with SONACT (P < 0.008 and <0.0015, resp.) while platelet count and fibrinogen levels depicted significant positive and negative correlations with clot rate and SONACT respectively. Conclusion. Sonoclot analysis may prove to be an efficient tool to assess coagulopathies in liver disease patients. Clot rate could emerge as a potential predictor of hypercoagulability in these patients.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

“…Coagulopathy is an important hallmark of hepatic dysfunction [59,60]. Patients with ACLF have complex hemostatic defects leading to a delicate, unstable balance between bleeding and thrombosis [61].…”

“…It requires global coagulation assessment to replicate in clinics. To overcome these limitations, viscoelastic methods (e.g., TEG and Rotem, Sonoclot) have been suggested for global coagulation assessment [61,63]. These tests measure the broad areas of initial clot formation, clotfibrin interaction, fibrin polymerization, platelet-clot-fibrin interaction, and fibrinolysis.…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…TEG parameters were a better predictor of bleeding risk in posttransplant patients who underwent renal biopsy in comparison to conventional tests [26]. SONOCLOT is a method that assesses in vitro global coagulation, especially systemic fibrinolysis, is an efficient tool to assess coagulopathies in patients with liver disease and can predict hypercoagulability [27]. Studies to validate the superiority of global hemostatic tests such as TEG and SONOCLT over PT/INR, aPTT and platelet counts prior to LB are unmet needs.…”

Serum cholinesterase as liver function test in cirrhotic patients at Soba Teaching hospital, Khartoum, Sudan

“…In this study, PT tend to increase significantly and albumin showed low level in cirrhotic patients compared to the controls. Liver disease patients (Saxena et al, 2013) have complex hemostatic defects leading to a delicate, unstable balance between bleeding and thrombosis. Both serum albumin and prothrombin time can be considered useful tools, alone or combined in clinical scores, for evaluating liver function (Bonis et al, 1999;Kamath et al, 2001;Botta et al 2003).…”