Managing Coagulation Using the Sonoclot Analyzer in Patients With Disseminated Intravascular Coagulation.

BACKGROUND

Evidence for the effectiveness of the Sonoclot analyzer in improving clinical outcomes in disseminated intravascular coagulation (DIC) is lacking.

OBJECTIVE

To evaluate the effectiveness of an algorithm based on the Sonoclot analyzer in improving the short-term prognosis of patients with DIC.

METHODS

A total of 279 patients with overt DIC who were admitted to the hospital within 18 months before and after implementation of the new Sonoclot-based algorithm were enrolled in the study. They were assigned to either a conventional coagulation assay (CCA) group (n = 148) or a Sonoclot group (n = 131). Data associated with anti-coagulation and transfusion were collected and analyzed. The 30-day survival rate after hospital admission was compared between groups.

RESULTS

The Sonoclot group had a higher 30-day survival rate than the CCA group (78.45% vs 63.64%; P = .02). The heparin dose, anticoagulation course, and major bleeding rate were significantly reduced in the Sonoclot group compared with the CCA group for all patients and for patients undergoing continuous renal replacement therapy (all P < .001). Fresh frozen plasma, platelet, and cryoprecipitate requirements were substantially lower in the Sonoclot group than in the CCA group (P = .007, .03, and .02, respectively). In a stratified analysis, improved survival rate was seen mainly in patients with moderately severe sepsis and heatstroke, with an Acute Physiology and Chronic Health Evaluation II score of 20 to 29.

CONCLUSION

The Sonoclot analyzer may be useful to guide coagulation management in patients with DIC. Use of the Sonoclot-based algorithm may improve outcomes for DIC patients with moderately severe sepsis or heatstroke.