Hemostasis testing in patients with liver dysfunction: Advantages and caveats

作     者：Guillaume Nguyen Manon Lejeune Benjamin Crichi Corinne Frere 

作者机构：Department of HematologyTrousseau HospitalAssistance Publique Hôpitaux de ParisParis 75012France Department of HematologyPitié-Salpêtrière HospitalAssistance Publique Hôpitaux de ParisParis 75013France Department of Internal MedicineSaint-Louis HospitalAssistance Publique Hôpitaux de ParisParis 75010France Inserm UMRS_1166Institute of Cardiometabolism and NutritionSorbonne UniversitéParis 75013France 

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42期

页      面：7285-7298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：Hemostasis Bleeding risk Conventional tests Thrombin generation Viscoelastic tests Hemostatic agents 

摘      要：Due to concomitant changes in pro-and anti-coagulant mechanisms,patients with liver dysfunction have a“rebalanced hemostasis,which can easily be tipped toward either a hypo-or a hypercoagulable *** are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis *** coagulation screening tests,such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk *** introduction of global coagulation assays,such as viscoelastic testing(VET),has been an important step forward in the assessment of the overall hemostasis profile.A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous *** present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.