PB1007 - Clot wave analysis parameters are associated with the severity of liver cirrhosis.

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Kessarin Thanapirom, MD, PhD

Consultant Hepatologist
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Bangkok, Krung Thep, Thailand

Co-Author(s)

PT

Pisit Tangkijvanich

Hepatologist
Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Bangkok, Krung Thep, Thailand
SS

Sirinporn Suksawatamnuay

Scientist
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Bangkok, Krung Thep, Thailand
PT

Panarat Thaimai

Scientist
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Bangkok, Krung Thep, Thailand
PA

Prooksa Ananchuensook

Consultant Hepatologist
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Bangkok, Krung Thep, Thailand
PK

Pitiphong Kijrattanakul

Consultant Hematologist
Division of Hospital and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
Bangkok, Krung Thep, Thailand
ST

Sombat Treeprasertsuk

Consultant Hepatologist
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Bangkok, Krung Thep, Thailand
Pantep Angchaisuksiri

Professor of Medicine and Chief of the Haemostasis and Thrombosis Unit
Department of Medicine, Ramathibodi Hospital, Mahidol University
Bangkok, Krung Thep, Thailand
PK

Piyawat Komolmit

Consultant Hepatologist
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Bangkok, Krung Thep, Thailand

Background: Clot wave analysis (CWA) provides a global hemostatic assessment and may be useful for cirrhosis with complex hemostatic abnormalities.

Aims: To evaluate the association between CWA values of prothrombin time (PT) and activated partial thromboplastin time (aPTT) and the severity of cirrhosis. Moreover, we prospectively evaluate the role of CWA in predicting acute decompensation (AD) in compensated cirrhotic patients.

Methods: Adult cirrhotic patients were prospectively enrolled at Chulalongkorn University Hospital from 2021 to 2023. Patients with active bleeding, bleeding disorders, antiplatelet/anticoagulant use, hemodialysis, and active malignancy were excluded. AD is defined as the acute development of ascites, variceal bleeding, overt hepatic encephalopathy, bacterial infection, jaundice, or their combination. CWA values were performed on the CS-2500 (Sysmex Corporation).

Results: A total of 466 cirrhotic patients were enrolled, with 144(30.9%) having decompensated cirrhosis. Of these, 123(26.4%) and 40(8.6%) had Child-Pugh B and C, respectively. Maximum velocity(min1), maximum acceleration(min2), and maximum deceleration(max2) of PT and aPTT CWA were significantly lower (p≤0.05) in decompensated patients than in those with compensated cirrhosis. Advanced stage of cirrhosis was associated with more hypocoagulable CWA parameters. Patients with Model For End-Stage Liver Disease (MELD) score≥18 had lower CWA values than those with MELD score < 18. The min1, min2, and max2 of PT CWA were significantly negatively correlated with Child-Pugh (r=-0.37 to -0.46,p≤0.001), MELD (r =-0.35 to -0.41,p≤0.001), and transient elastography evaluated by Fibroscan (r=-0.16 to -0.26,p≤0.05). There was no significant difference in CWA values between patients with and without portal vein thrombosis. Among compensated cirrhotic patients at baseline, 11.8% (38/322) developed AD within one year of follow-up. Baseline PT-based CWA values were significantly lower in patients who developed decompensating events compared to those without.

Conclusion(s): Hypocoagulable CWA measurements are associated with advanced cirrhotic stage and the progression to decompensated complications. CWA may be a useful marker of the severity of cirrhosis.