Intraoperative Sonoclot analysis in oncosurgical massive hemorrhage: A case series of coagulation curve abnormalities

Reports on intraoperative coagulation monitoring using viscoelastic testing methods are scarce in oncosurgical patients. Evidence-based clinical reports with the use of Sonoclot and subsequent corrections of coagulation abnormalities in above population are not available in the literature. We report here records of altered coagulation in 10 subjects with massive hemorrhage. Detection of intraoperative coagulation abnormalities was done using activated clotting time, clot rate, and platelet function. The most common Sonoclot signature abnormality found in our series was a poorly formed, dull, and rounded "peak," indicative of irregularities of fibrin formation. Dilutional coagulopathy and hyper-fibrinolysis events too were recorded in few subjects. Appropriate transfusions with blood products were considered based on Sonoclot curve assessment. All subjects had adequate recovery. We conclude that the Sonoclot analysis demonstrates potential for optimizing blood product use in oncosurgical patients with massive hemorrhage, warranting further research to establish standardized protocols and quantify its impact.