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Coagulation Management in End-Stage Liver Disease

  • Blood Management (KA Tanaka, Section Editor)
  • Published:
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A Correction to this article was published on 16 May 2022

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Abstract

Purpose of Review

There is a precarious and altered balance in the hemostatic function encountered in patients with end-stage liver disease (ESLD). Anesthetic management of such patients is challenging with no clear guidelines for management of coagulopathy. This review helps in understanding this altered hemostatic physiology along with management of coagulopathy.

Recent Findings

Coagulation is not abnormal in patients with ESLD, rather there is altered equilibrium in the procoagulants and anticoagulants. Commonly used laboratory tests do not predict the bleeding-risk, and there is little benefit in prophylactic administration of blood products to correct the abnormal laboratory tests.

Summary

Point-of-care tests based on viscoelastic properties of blood have been more useful than conventional tests in guiding blood product administration in patients with ESLD. Coagulation factor concentrates (fibrinogen concentrate and/or prothrombin complex concentrate) are increasingly used as alternatives to traditionally administered blood products like cryoprecipitate and frozen plasma, possessing several benefits and without any increased adverse effects. Further research is warranted for these alternative products to be universally recommended.

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  1. Department of Anesthesiology, University of Oklahoma Health - Sciences – Center, PO Box 26901, Oklahoma City, OK, 73126, USA

    Shashank S. Shettar, Kofi Vandyck & Kenichi A. Tanaka

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Correspondence to Shashank S. Shettar.

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Shashank S. Shettar declares he has no conflict of interest; Kenichi A. Tanaka received fees for serving on the scientific advisory board for HemoSonics and Octapharma; Kofi VanDyck reports research fees from HemoSonics, outside the submitted work for trial of Quantra Qstat cartridge for Quantra Hemostasis Analyzer.

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This article is part of the Topical Collection on Blood Management

The original online version of this article was revised to correct the following errors: (1) In Table 2, the phrase “Quantra® Sigma” should be corrected to “Quantra® QStat”. (2) In Fig. 1, “QState Cartridge” should be corrected to “Qstat Cartridge”.

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Shettar, S.S., Vandyck, K. & Tanaka, K.A. Coagulation Management in End-Stage Liver Disease. Curr Anesthesiol Rep 12, 297–306 (2022). https://doi.org/10.1007/s40140-022-00524-2

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