title: Point-of-Care Testing in Liver Disease and Liver Surgery.
abstract: The alterations in coagulation and hemostasis that accompany liver disease are complex, and while patients with this disease have traditionally been perceived as having a bleeding diathesis, it is now understood that in stable patients hemostasis is "re-balanced." Hepatic surgery, and particularly liver transplantation, can be associated with large fluid shifts, massive bleeding, and coagulopathy, as well as postoperative thrombosis. Point-of-care tests (POCTs) of coagulation facilitate goal-directed treatments and hemostatic monitoring in dynamic environments where the coagulation status can alter rapidly and often unpredictably. POCTs reflect more accurately the re-balanced hemostatic system than do conventional coagulation tests (CCTs). Viscoelastic POCT-guided transfusion algorithms permit a reduction in blood product administration and are a key component of patient blood management programs. Moreover, viscoelastic POCTs are better able to identify patients with hypercoagulability than CCTs. With thrombosis increasingly recognized to be a problem in patients with liver disease, POCTs hold promise for both individualized bleeding and thrombosis management.
authors.affiliation: Department of Anaesthesia, Royal Free Hospital, Royal Free Perioperative Research Group, London, United Kingdom.
authors.forename: Lasitha
authors.initials: L
authors.lastname: Abeysundara
authors.affiliation: Department of Anaesthesia, Royal Free Hospital, Royal Free Perioperative Research Group, London, United Kingdom.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Mallett
authors.affiliation: Department of Anaesthesia, Royal Free Hospital, Royal Free Perioperative Research Group, London, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Clevenger
mesh_terms: D001777:Blood Coagulation; D001780:Blood Coagulation Tests / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000097:blood*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D013916:Thrombelastography / Q000379:methods