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Viscoelastic test-based bleeding risk score reliably predicts coagulopathic bleeding in decompensated cirrhosis and

Chhagan Bihari1, Anupama Patil1, Saggere Muralikrishna Shasthry2

  • 1Department of Pathology and Hematology, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi, India.

Hepatology International
|April 19, 2020
PubMed

Insights

A new viscoelasticity-based bleeding risk score using activated clotting time (ACT), platelet function (PF), and fibrinogen effectively predicts coagulopathic bleeding in decompensated cirrhosis (DC) patients.

Area of Science:

  • Hepatology
  • Coagulation Science
  • Medical Diagnostics

Background:

  • Predicting coagulopathic bleeding in decompensated cirrhosis (DC) is challenging with conventional assays.
  • Viscoelastic tests (VETs) offer a more comprehensive assessment of coagulation status.
  • The Sonoclot VET was evaluated for its utility in predicting bleeding events.

Purpose of the Study:

  • To investigate the predictive value of Sonoclot VET parameters and fibrinogen for coagulopathic bleeding in DC patients.
  • To develop and validate a bleeding risk score for DC patients.
  • To assess the score's utility in acute-on-chronic liver failure (ACLF) and its correlation with mortality.

Main Methods:

  • Coagulation parameters were measured in 874 patients (compensated cirrhosis, DC, ACLF) and 190 controls.
  • Sonoclot variables (ACT, CR, PF, TP, PA) and fibrinogen levels were analyzed.
  • A bleeding risk score was developed using Cox regression in a derivation cohort and validated in a separate cohort.

Main Results:

  • DC patients exhibited significantly prolonged ACT, longer TP, and smaller PA compared to controls.
  • A bleeding risk score incorporating ACT, PF, and fibrinogen accurately predicted coagulopathic bleeding in both derivation and validation cohorts.
  • The score was also predictive in ACLF patients, and higher scores correlated with increased 1-year mortality due to bleeding.

Conclusions:

  • A viscoelasticity-based bleeding risk score using ACT, PF, and fibrinogen effectively predicts coagulopathic bleeding in DC patients.
  • This score can aid in the rational transfusion of blood products.
  • The developed score is valuable for predicting bleeding complications in advanced liver disease.
Abstract

Keywords:
ACLFActivated clotting timeClot rateCoagulationCoagulopathic bleedingCompensated cirrhosisDecompensated cirrhosisFibrinogenPlateletsSonoclot

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