Point-of-Care Testing in Liver Disease and Liver Surgery

Area of Science:

• Hepatology
• Hematology
• Anesthesiology

Background:

• Liver disease causes complex coagulation and hemostasis alterations, historically viewed as a bleeding risk.
• Stable liver disease patients exhibit a re-balanced hemostatic state, challenging traditional perceptions.
• Hepatic surgery and transplantation involve significant risks of bleeding, coagulopathy, and postoperative thrombosis.

Purpose of the Study:

• To evaluate the role of point-of-care tests (POCTs) in managing hemostasis in liver disease patients.
• To compare the efficacy of POCTs with conventional coagulation tests (CCTs) in dynamic surgical settings.
• To explore the potential of POCTs in managing both bleeding and hypercoagulable states in liver disease.

Main Methods:

• Utilized viscoelastic point-of-care tests (POCTs) for coagulation monitoring.
• Employed goal-directed treatment strategies guided by POCT results.
• Compared POCT performance against conventional coagulation tests (CCTs).

Main Results:

• POCTs provide a more accurate reflection of the re-balanced hemostatic system in liver disease than CCTs.
• Viscoelastic POCT-guided algorithms reduce blood product administration, supporting patient blood management.
• POCTs are more effective than CCTs in identifying patients with hypercoagulability.

Conclusions:

• POCTs are valuable tools for precise hemostatic monitoring and management in liver disease patients undergoing surgery.
• Viscoelastic POCTs facilitate individualized management of both bleeding and thrombosis risks.
• POCTs represent a promising advancement for optimizing patient care in complex liver disease scenarios.