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.
Highlights
Liver disease patients have complex hemostatic defects leading to a delicate, unstable balance between bleeding and thrombosis
We found a significant positive correlation between fibrinogen levels, platelet counts and clot rate (CR), platelet function (PF), peak amplitude (PA) and a significant negative correlation between these two conventional parameters and sonoclot activated clotting time (SONACT) and to peak (TP)
While coagulopathy is the hallmark of acute-on-chronic liver failure (ACLF) group, the diagnostic tests of coagulation are frequently abnormal in patients with decompensated cirrhosis too [11]
Summary
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. Routine diagnostic tests such as platelet count, prothrombin time (PT), and activated partial thromboplastin time (APTT) are frequently abnormal. Interpretation of these tests is much less accurate in patients with complex hemostatic disorders as can be found in patients with liver disease [1]. Significant variations in the INR values have been reported in liver disease patients when tested in different laboratories Due to this poor reproducibility of INR values, models for end stage liver disease (MELD) score variations up to 12 points have been noted [3]. This could lead to significant discrepancies in the management of these patients
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