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Hemostasis testing in patients with liver dysfunction: Advantages and caveats.
Guillaume Nguyen1, Manon Lejeune2, Benjamin Crichi3
1Department of Hematology, Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris 75012, France.
World Journal of Gastroenterology
|December 8, 2021
Summary
Patients with liver dysfunction have rebalanced hemostasis. Viscoelastic testing (VET) offers a better assessment of bleeding risk than conventional tests, potentially reducing unnecessary blood product transfusions.
Area of Science:
- Hepatology
- Hematology
- Clinical Coagulation
Background:
- Patients with liver dysfunction exhibit "rebalanced hemostasis," prone to hypo- or hypercoagulable states.
- Conventional coagulation tests (PT/INR, aPTT) have limitations in assessing bleeding risk in chronic liver disease (CLD).
- Predicting bleeding risk before invasive procedures in CLD patients remains a clinical challenge.
Purpose of the Study:
- To review the advantages and limitations of conventional and global coagulation assays.
- To discuss the clinical utility of viscoelastic testing (VET) in patients with CLD.
- To explore current strategies for managing bleeding in CLD patients.
Main Methods:
- Review of current literature on coagulation assessment in liver disease.
- Comparison of conventional coagulation screening tests with global coagulation assays like VET.
- Analysis of evidence supporting the use of VET in clinical practice.
Main Results:
- Conventional tests inadequately predict bleeding risk in CLD patients undergoing procedures.
- Viscoelastic testing (VET) provides a comprehensive assessment of the hemostasis profile.
- VET may help prevent unnecessary blood product transfusions and improve patient outcomes.
Conclusions:
- Viscoelastic testing (VET) represents a significant advancement in assessing hemostasis in liver disease.
- VET may guide transfusion strategies and improve management of bleeding in CLD.
- Further research is warranted to optimize the role of VET and hemostatic agents.
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