Clot wave analysis and thromboembolic score in liver cirrhosis: two opposing phenomena

What is it about?

Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are abnormal but unreliable in cirrhotic patients to express their risk of bleeding. However, these patients may also suffer from thrombotic episodes. In order to investigate the dynamics of the formation of fibrin, we studied the clot waveform analysis (CWA) of aPTT together with a score for the evaluation of the thromboembolic risk. In particular, we investigated the dynamics of the formation of fibrin, i.e. the clot waveform analysis of aPTT, in terms of velocity (1st derivative), acceleration (2nd derivative) and density (Delta). CWA is available by means of an automated coagulometer using an implemented software. In conclusion, two opposing tendencies seem to be present in cirrhotic disease: the first shows a weakness of clot formation while the second a predisposition towards thrombosis, identified by the PPS (Padua Prediction Score).

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Why is it important?

Our study of the clot waveform analysis could therefore be useful in clinical practice to better evaluate the coagulative state of cirrhotic patients, where routine tests (PT and aPTT) have proved to be deficient. The parameters Delta, 1st and 2nd derivatives therefore provide a valid alternative to other techniques of studying the dynamics of clot formation, such as thrombus elastography and the thrombin generation test, as the cheapest and most versatile of all lab techniques.