Viscoelastic tests in liver disease: where do we stand now?
Autor: | Alina Buliarca, Zeno Sparchez, Rares Craciun, Adelina Horhat, Bogdan Procopet, Tudor Mocan |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
medicine.drug_class Invasive procedures Chronic liver disease 03 medical and health sciences 0302 clinical medicine Internal medicine Bleeding risk medicine Coagulation testing Humans Prothrombin time Hemostasis medicine.diagnostic_test Viscoelastic tests business.industry Liver Diseases Anticoagulant Gastroenterology Minireviews General Medicine Blood Coagulation Disorders medicine.disease Thrombosis Portal vein thrombosis Thromboelastography Thrombelastography Thromboelastometry Acute-on-chronic liver failure 030220 oncology & carcinogenesis Cardiology 030211 gastroenterology & hepatology Blood Coagulation Tests business |
Zdroj: | World Journal of Gastroenterology |
ISSN: | 2219-2840 1007-9327 |
Popis: | Hemostasis is a complex physiological process based on the balance between pro-coagulant and anticoagulant systems to avoid pathological bleeding or thrombosis. The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder, and cirrhotic patients were considered naturally anticoagulated. In the light of the new evidence, the theory of rebalanced hemostasis replaced the old concept. According to this model, the hemostatic alteration leads to a unique balance between pro-coagulant, anticoagulant, and fibrinolytic systems. But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors. The standard coagulation tests [INR (international normalized ratio), platelet count and fibrinogen] only explore parts of the hemostasis, not offering an entire image of the process. Rotational 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 disease. However, bleeding remains the dominant clinical issue in patients with liver diseases, especially when invasive interventions are required. VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests, leading to decrial use of blood products transfusion. Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET. Although 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. |
Databáze: | OpenAIRE |
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