Semin Thromb Hemost 2017; 43(04): 407-415
DOI: 10.1055/s-0037-1599154
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Point-of-Care Testing in Liver Disease and Liver Surgery

Lasitha Abeysundara
1   Department of Anaesthesia, Royal Free Hospital, Royal Free Perioperative Research Group, London, United Kingdom
,
Susan V. Mallett
1   Department of Anaesthesia, Royal Free Hospital, Royal Free Perioperative Research Group, London, United Kingdom
,
Ben Clevenger
1   Department of Anaesthesia, Royal Free Hospital, Royal Free Perioperative Research Group, London, United Kingdom
› Author Affiliations
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.

Note

No financial support was provided for this article. All authors contributed to the final draft of the manuscript.


 
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