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Semin Thromb Hemost 2020; 46(06): 704-715
DOI: 10.1055/s-0040-1715475
Review Article

Viscoelastic Tests as Point-of-Care Tests in the Assessment and Management of Bleeding and Thrombosis in Liver Disease

Natasha Janko
1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
2   Central Clinical School, Monash University, Melbourne, Victoria, Australia
,
Ammar Majeed
1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
2   Central Clinical School, Monash University, Melbourne, Victoria, Australia
,
William Kemp
1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
2   Central Clinical School, Monash University, Melbourne, Victoria, Australia
,
Stuart K. Roberts
1   Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
2   Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Abstract

Viscoelastic point-of-care (VET POC) tests provide a global assessment of hemostasis and have an increasing role in the management of bleeding and blood component delivery across several clinical settings. VET POC tests have a rapid turnaround time, provide a better overall picture of hemostasis, predict bleeding more accurately than conventional coagulation tests, and reduce blood component usage and health care costs. Despite commonly having abnormal conventional coagulation tests, most patients with chronic liver disease have a “rebalanced” hemostasis. However, this hemostatic balance is delicate and these patients are predisposed to both bleeding and thromboembolic events. Over recent years, VET POC tests have been increasingly studied for their potential as better functional tests of hemostasis in liver disease patients. This review provides a background on the most common VET POC tests (thromboelastography and rotational thromboelastometry) and discusses the current evidence for these tests in the prediction and management of bleeding and thrombosis in patients with chronic liver disease, and in liver resection and transplant. With the recent publication of several randomized controlled trials, there is growing evidence that VET POC tests may be used to improve bleeding risk assessment and reduce blood product use in liver disease patients outside of the transplant setting. However, consensus is still lacking regarding the VET POC tests' thresholds that should be used to trigger blood product transfusion. VET POC tests also show promise in predicting thrombosis in patients with liver disease, but further research is needed before they can be used to guide anticoagulant therapy.

Keywords

liver disease - thromboelastography - rotational thromboelastometry - sonorheometry - coagulation - cirrhosis


Publication History

Article published online:
15 September 2020

© 2020. Thieme. All rights reserved.

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