Reversible sorafenib-associated coagulopathy identified by viscoelastic testing in a dog with intranasal sarcoma.

Sorafenib causes reversible coagulopathy detectable by viscoelastic testing; discontinuation resolves coagulopathy.

This case report describes a 50 kg Labrador Retriever with recurrent intranasal sarcoma treated with sorafenib (5 mg/kg daily), a multi-kinase inhibitor targeting overexpressed platelet-derived growth factor receptors. After 132 days of stable disease, the dog developed worsening nasal discharge, epistaxis, and respiratory effort. Standard coagulation tests (PT, aPTT, D-dimer) were normal, but viscoelastic testing revealed hypocoagulability with delayed clot initiation and markedly decreased clot development and firmness. Sorafenib discontinuation resulted in progressive resolution of coagulopathy parameters on follow-up viscoelastic testing (days 149, 170, 191) with concurrent clinical improvement. This case establishes sorafenib as a potential cause of reversible coagulopathy in dogs and demonstrates the superior diagnostic sensitivity of viscoelastic testing compared to conventional coagulation assays for detecting tyrosine kinase inhibitor-associated hemostatic abnormalities. The findings highlight the importance of monitoring hemostatic function during tyrosine kinase inhibitor therapy in veterinary oncology patients.

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