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Viscoelastic testing in liver transplantation
Author(s) -
Sakai Tetsuro
Publication year - 2020
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16077
Subject(s) - medicine , hemostasis , liver transplantation , randomized controlled trial , coagulation , clinical trial , coagulation testing , liver disease , intensive care medicine , transplantation , surgery , disease
Despite the lack of large randomized clinical studies, viscoelastic tests (VETs) have been a critical armamentarium for hemostatic control in liver transplantation (LT) since the 1960s. Many transplant institutions have adopted VETs in their clinical practice. Several small‐size randomized clinical trials on LT patients have suggested that VET‐guided hemostatic treatment algorithms have led to decreased indications for and amounts of transfused blood products, especially fresh‐frozen plasma, compared to standard laboratory‐based hemostatic management. VETs have also been reported to offer insight into the diagnosis and prediction of LT patients' development of hypercoagulability‐related morbidity and mortality. There is still a need for VET device–specific hemostatic algorithms in LT, and clinicians must take into account the tendency to underestimate the coagulation capacity of VETs in patients with end‐stage liver disease where hemostasis is rebalanced.