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Hemostasis testing in patients with liver dysfunction: Advantages and caveats

World Journal of Gastroenterology 2021年第42期27卷 7285-7298页

作者： Guillaume Nguyen Manon Lejeune Benjamin Crichi Corinne Frere Department of Hematology Trousseau HospitalAssistance Publique Hôpitaux de ParisParis 75012France Department of Hematology Pitié-Salpêtrière HospitalAssistance Publique Hôpitaux de ParisParis 75013France Department of Internal Medicine Saint-Louis HospitalAssistance Publique Hôpitaux de ParisParis 75010France Inserm UMRS_1166 Institute of Cardiometabolism and NutritionSorbonne UniversitéParis 75013France

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.

关键词： Hemostasis Bleeding risk Conventional tests Thrombin generation Viscoelastic tests hemostatic agents

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Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding

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World Journal of Gastrointestinal Endoscopy 2024年第7期16卷 376-384页

作者： Xue Jing Li Brian M Fung Department of Gastroenterology and Hepatology Banner-University Medical Center PhoenixPhoenixAZ 85006United States

Non-variceal upper gastrointestinal(GI)bleeding is a significant cause of morbidity and ***,through-the-scope(TTS)clips,thermal therapy,and injection therapies are used to treat GI *** this review,we provide an overview of novel endoscopic treatments that can be used to achieve ***,we discuss the efficacy and applicability of over-thescope clips,hemostatic agents,TTS doppler ultrasound,and endoscopic ultrasound,each of which offer an effective method of reducing rates of GI rebleeding.

关键词： Doppler probe Endoscopic ultrasound Endoscopy techniques Gastrointestinal bleeding Hemospray Hemostasis hemostatic agents Over-the-scope clips Ovesco

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