Coagulation Management in End-Stage Liver Disease

AbstractPurpose of ReviewThere 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 FindingsCoagulation 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.SummaryPoint-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.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research