Viscoelastic Testing in Liver Disease.

Annals of Hepatology
Jessica P E DavisNicolas M Intagliata

Abstract

Long thought to be hypocoagulable, new evidence suggests cirrhosis patients have "rebalanced" coagulation in the setting of decreased synthesis of both pro- and anti-coagulant factors. Traditional testing like PT/INR reflects only the decreased synthesis of pro-coagulant factors and thus does not correspond to bleeding or clotting risk in this population. In this review, we discuss the use of viscoelastic testing (VET), an assay of global hemostasis in cirrhosis patients. We describe the technique and interpretation of commercially available VET and assess the application of VET in both transplant and non-transplant cirrhosis populations. VET largely correlates well with traditional testing including platelet count and fibrinogen level, however, is potentially less accurate in patients with low fibrinogen levels. VET may be useful in identifying patients at higher risk of hypercoagulable complications post-transplant and reflects changes in hemostasis in decompensated patients. While VET has been associated with decreased transfusión support in multiple studies, the lack of bleeding in patients who avoided prophylactic transfusion suggests a "rescue" rather than prophylactic approach to transfusion may be ideal and further stud...Continue Reading

Citations

Aug 25, 2018·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Patrick Northup, Bethany Reutemann
Oct 30, 2019·European Journal of Haematology·Patricia LiuJoseph Shatzel
Mar 7, 2020·Current Opinion in Gastroenterology·Matthew J StottsNeeral L Shah
Aug 28, 2020·Clinical Science·Jessica P E Davis, Stephen H Caldwell
Aug 21, 2020·Seminars in Thrombosis and Hemostasis·Saro Khemichian, Norah A Terrault
Nov 9, 2019·Hepatology Communications·Kathy M NillesSteven L Flamm
Sep 16, 2020·Seminars in Thrombosis and Hemostasis·Natasha JankoStuart K Roberts
Nov 22, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Patrick G NorthupDominique C Valla
Nov 10, 2020·Clinical Liver Disease·Abhishek Shenoy, Nicolas M Intagliata
Dec 15, 2020·World Journal of Transplantation·Lesley De PietriFabrizio Di Benedetto
Jan 16, 2021·Journal of Clinical and Translational Hepatology·Ahyoung KimPo-Hung Chen
Sep 29, 2021·Gastroenterology·Nicolas M IntagliataJonathan G Stine

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