Association between Clot Waveform Analysis Parameters and the Severity of Liver Cirrhosis

Abstract

Background

Clot waveform analysis (CWA) provides a global assessment of hemostasis and may be useful for patients with cirrhosis with complex hemostatic abnormalities. This study aimed to assess the association between prothrombin time (PT-) and activated partial thromboplastin time (aPTT-) based CWA parameters and cirrhosis severity and prospectively evaluate the role of CWA in predicting mortality and acute decompensation (AD) over 1 year.

Methods

This prospective study included adult patients with cirrhosis between June 2021 and December 2023 at Chulalongkorn University Hospital. The PT- and aPTT-based CWA parameters were obtained using an automated coagulation analyzer.

Results

A total of 560 patients with cirrhosis were included; 165 (29.5%) and 47 (11.5%) had Child–Turcotte–Pugh (CTP) B and C cirrhosis, respectively. The PT- and aPTT-based CWA parameters, including maximum velocity (min1), maximum acceleration (min2), and maximum deceleration (max2), were significantly lower (p ≤ 0.05) in patients with decompensated cirrhosis than in those with compensated cirrhosis. Additionally, CWA values were significantly higher in patients with higher CTP and Model for End-Stage Liver Disease (MELD) scores. Multivariable analysis revealed that liver stiffness (LS) and max2 of PT-based CWA assay were independently associated with CTP B/C. In addition, min2 and max2 of PT-based CWA assay were independently associated with 1-year mortality. No significant differences in CWA parameters were observed between patients with and without portal vein thrombosis. CWA parameters were not related to AD during the 1-year follow-up.

Conclusion

A hypocoagulable profile based on CWA parameters is associated with advanced-stage cirrhosis. CWA may be a useful objective marker for assessing cirrhosis severity and predicting 1-year mortality.

Keywords

clot wave analysis - cirrhosis - severity of liver cirrhosis - portal vein thrombosis - clinical outcomes

Authors' Contribution

K.T. and P.K. designed the study, analyzed the results, and wrote the manuscript. K.T., S.S., Panarat Thaimai, Prooksa Ananchuensook, Pitiphong Kijrattanakul, Pantep Angchaisuksiri, S.T., and Pisit Tangkijvanich were involved in data curation and formal analysis. S.S. performed clot wave analysis value measurement. All authors had access to the study data and reviewed, and approved the final version of this manuscript.

Publication History

Received: 13 August 2024

Accepted: 16 December 2024

Article published online:
09 January 2025

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