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Semin Thromb Hemost 2017; 43(04): 407-415
DOI: 10.1055/s-0037-1599154
DOI: 10.1055/s-0037-1599154
Review Article
Point-of-Care Testing in Liver Disease and Liver Surgery
Further Information
Publication History
Publication Date:
30 March 2017 (online)
Abstract
The alterations in coagulation and hemostasis that accompany liver disease are complex, and while patients with this disease have traditionally been perceived as having a bleeding diathesis, it is now understood that in stable patients hemostasis is “re-balanced.” Hepatic surgery, and particularly liver transplantation, can be associated with large fluid shifts, massive bleeding, and coagulopathy, as well as postoperative thrombosis. Point-of-care tests (POCTs) of coagulation facilitate goal-directed treatments and hemostatic monitoring in dynamic environments where the coagulation status can alter rapidly and often unpredictably. POCTs reflect more accurately the re-balanced hemostatic system than do conventional coagulation tests (CCTs). Viscoelastic POCT-guided transfusion algorithms permit a reduction in blood product administration and are a key component of patient blood management programs. Moreover, viscoelastic POCTs are better able to identify patients with hypercoagulability than CCTs. With thrombosis increasingly recognized to be a problem in patients with liver disease, POCTs hold promise for both individualized bleeding and thrombosis management.
Keywords
point-of-care test - cirrhosis - liver transplant - thromboelastography - rotational thromboelastometryNote
No financial support was provided for this article. All authors contributed to the final draft of the manuscript.
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