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Clinical utility of viscoelastic tests of coagulation in patients with liver disease
Author(s) -
Mallett Susan V.,
Chowdary Pratima,
Burroughs Andrew K.
Publication year - 2013
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12158
Subject(s) - medicine , liver disease , observational study , coagulation , prothrombin time , chronic liver disease , coagulation testing , disease , intensive care medicine , liver function tests , gastroenterology , cirrhosis
The prothrombin time ( PT ) and international normalised ratio ( INR ) are used in scoring systems (Child‐Pugh, MELD , UKELD ) in chronic liver disease and as a prognostic tool and for dynamic monitoring of hepatic function in acute liver disease. These tests are known to be poor predictors of bleeding risk in liver disease; however, they continue to influence clinical management decisions. Recent work on coagulation in liver disease, in particular thrombin generation studies, has led to a paradigm shift in our understanding and it is now recognised that haemostasis is relatively well preserved. Whole blood global viscoelastic tests ( TEG ® / ROTEM ® ) produce a composite dynamic picture of the entire coagulation process and have the potential to provide more clinically relevant information in patients with liver disease. We performed a systematic review of all relevant studies that have used viscoelastic tests ( VET ) of coagulation in patients with liver disease. Although many studies are observational and small in size, it is clear that VET provide additional information that is in keeping with the new concepts of how coagulation is altered in these patients. This review provides the basis for large scale, prospective outcome studies to establish the clinical value of these tests.