Sonoclot Analysis for the Point of Care Diagnosis of Hyperfibrinolysis During Orthotopic Liver Transplantation

Abstract

Abstract To properly and effectively manage coagulation disorders during orthotopic liver transplantation, clinicians need reliable and rapid data. From this point of view, the diagnosis of hyperfibrinolysis can be particularly challenging. Among 40 cirrhotic patients consecutively undergoing orthotopic liver transplantation at our center, 11 (27.5%) showed coagulopathy during the surgical procedure. In 5 (45.4%) of them, the Sonoclot analysis diagnosed hyperfibrinolysis (normal onset, rate, and peak but abrupt deflection toward the baseline), whereas traditional laboratory tests on simultaneously drawn blood samples showed no significant changes from their baseline values. The administration of intravenous tranexamic acid stopped the bleeding and normalized the Sonoclot trace in all of them. In the remaining 6 (54.6%) patients, both the Sonoclot analysis and the laboratory tests highlighted blood coagulation factor deficiencies, which were treated with fresh frozen plasma or platelets. The turnaround time was 23.8 ± 3.5 minutes for the Sonoclot analysis and 54.2 ± 7.2 minutes for the traditional laboratory tests. Although not widely used, in our experience the Sonoclot analysis provides rapid and useful data for the recognition and the management of hyperfibrinolysis, a coagulation disorder where simple and reliable laboratory tests are not available within sufficiently short times to satisfy intraoperative clinical needs.