Abstract
Viscoelastic point-of-care (VET POC) tests provide a global assessment of hemostasis
and have an increasing role in the management of bleeding and blood component delivery
across several clinical settings. VET POC tests have a rapid turnaround time, provide
a better overall picture of hemostasis, predict bleeding more accurately than conventional
coagulation tests, and reduce blood component usage and health care costs. Despite
commonly having abnormal conventional coagulation tests, most patients with chronic
liver disease have a “rebalanced” hemostasis. However, this hemostatic balance is
delicate and these patients are predisposed to both bleeding and thromboembolic events.
Over recent years, VET POC tests have been increasingly studied for their potential
as better functional tests of hemostasis in liver disease patients. This review provides
a background on the most common VET POC tests (thromboelastography and rotational
thromboelastometry) and discusses the current evidence for these tests in the prediction
and management of bleeding and thrombosis in patients with chronic liver disease,
and in liver resection and transplant. With the recent publication of several randomized
controlled trials, there is growing evidence that VET POC tests may be used to improve
bleeding risk assessment and reduce blood product use in liver disease patients outside
of the transplant setting. However, consensus is still lacking regarding the VET POC
tests' thresholds that should be used to trigger blood product transfusion. VET POC
tests also show promise in predicting thrombosis in patients with liver disease, but
further research is needed before they can be used to guide anticoagulant therapy.
Keywords
liver disease - thromboelastography - rotational thromboelastometry - sonorheometry
- coagulation - cirrhosis
