Clot microstructure in liver disease
Research type
Research Study
Full title
Variation in clot microstructure in different stages of liver disease
IRAS ID
367987
Contact name
Suresh Pillai
Contact email
Sponsor organisation
Swansea University
Duration of Study in the UK
1 years, 2 months, 28 days
Research summary
Liver diseases are silent killers and more than 12,000 people die each year. Whilst the mortality rates are falling in other chronic diseases, the death rate in liver diseases has quadrupled from 1970s. It exerts a financial burden of £17 billion annually to NHS. Cirrhosis or end stage liver disease develops progressively over several years. Patients with chronic or acute liver failure frequently show profound abnormalities in their haemostatic system. Whereas routine laboratory tests of haemostasis suggest these haemostatic alterations result in a bleeding diathesis, accumulating evidence from both clinical and laboratory studies suggest that the situation is more complex. The haemostatic pathways in patients with chronic liver disease are directly affected by disease progression and hepatic decompensation. While historically considered to be “auto anticoagulated” because of an inherent reduction of prothrombotic proteins and thrombocytopenia, evidence now firmly supports a new paradigm recognizing that both anti- and procoagulant pathways are altered, resulting in a fragile but re-balanced coagulation system that sometimes favours thrombosis. The standard coagulation tests which only explore parts of haemostasis do not offer a clear picture of the process. Viscoelastic tests such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG) can provide a real time and dynamic information about the entire haemostatic process. Fractal dimension (df), is a functional biomarker of blood coagulation that quantifies the clot microstructure. Previous studies have demonstrated that high df indicates dense clot microstructure that is impermeable to thrombolysis and low df indicates loose and less compact clot microstructure that is easy to breakdown. The changes in blood coagulation in liver disease has not been investigated at clot microstructure level. Therefore, the aim of this study is to determine the changes in clot microstructure in liver diseases.
REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
26/EM/0107
Date of REC Opinion
15 May 2026
REC opinion
Favourable Opinion