[Coagulation management in patients with liver disease].
BACKGROUND
End-stage liver disease is associated with complex alterations in hemostasis. Whereas prognosis is essentially affected by life-threatening bleeding complications in some patients, others, especially those with cholestatic liver diseases, suffer from thromboembolic complications. Standard laboratory values (SLVS; prothrombin time, activated partial thrombin time, platelet count) cannot sufficiently reflect the altered balance of pro- and anticoagulatory factors. Moreover, a couple of studies indicated that SLVS are not able to predict bleeding complications in patients with acute liver failure or decompensated liver cirrhosis.


METHODS
Use of bed-side coagulation diagnostics such as thrombelastometry/-graphy, detection of thrombocyte function by multiple electrode aggregometry and selective measurement of single factors allows a targeted and causal therapy of hepatic coagulopathies especially in the context of bleeding complications or surgical interventions. In recent years, coagulation management guided by these new devices has contributed to a reduction in transfusion of allogenic blood products, which may be associated with undesirable side effects.


CONCLUSIONS
The current review summarizes the complex pathophysiological alterations of hemostasis associated with advanced liver insufficiency and discusses recent upcoming diagnostics and coagulation management in this patient cohort.
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland. anja.bienholz@uk-essen.de.|Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland. anja.bienholz@uk-essen.de.
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Bienholz
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
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Canbay
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
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Saner
D001780:Blood Coagulation Tests; D003422:Critical Care / Q000379:methods*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D016031:Liver Transplantation; D000067716:Point-of-Care Testing; D011379:Prognosis; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*
Bleeding; Blood cagulation disorders; Hepatitis C; Liver transplantation; Thrombosis