Viscoelastic tests in liver disease: where do we stand now?

作     者：Alina Buliarca Adelina Horhat Tudor Mocan Rares Craciun Bogdan Procopet Zeno Sparchez 

作者机构：The Third Medical Department“Iuliu Hatieganu”University of Medicine and PharmacyInstitute for Gastroenterology and Hepatology“Prof.Dr.O.Fodor”Cluj-Napoca 400162Romania 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第23期

页      面：3290-3302页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Liver diseases Viscoelastic tests Portal vein thrombosis Acute-on-chronic liver failure Bleeding risk Invasive procedures 

摘      要：Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or *** changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder,and cirrhotic patients were considered naturally *** the light of the new evidence,the theory of rebalanced hemostasis replaced the old *** to this model,the hemostatic alteration leads to a unique balance between pro-coagulant,anticoagulant,and fibrinolytic *** the balance is fragile and may prone to bleeding or thrombosis depending on various risk *** standard coagulation tests[INR(international normalized ratio),platelet count and fibrinogen]only explore parts of the hemostasis,not offering an entire image of the *** thromboelastometry(ROTEM)and thromboelastography(TEG)are both point of care viscoelastic tests(VET)that provide real-time and dynamic information about the entire hemostasis process,including clot initiation(thrombin generation),clot kinetics,clot strength,and clot stability(lysis).Despite prolonged PT/INR(international normalized ratio of prothrombin time)and low platelet counts,VET is within the normal range in many patients with both acute and chronic liver ***,bleeding remains the dominant clinical issue in patients with liver diseases,especially when invasive interventions are *** has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests,leading to decrial use of blood products *** clotting is common but often subtle and may be challenging to predict even with the help of *** VET has shown its benefit,more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.