Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
Curr Opin Gastroenterol. 2020 May;36(3):169-176. doi: 10.1097/MOG.0000000000000635.
The present article aims to provide clinicians with an overview of coagulation testing in individuals with liver disease, to discuss available procoagulants and the rationale for their use, and to provide management strategies in a variety of common clinical scenarios.
Clinicians and researchers are gaining an increased understanding of the shortfalls of assessing bleeding risk using traditional tests of coagulation. The use of global tests of clot formation, including viscoelastic testing and thrombin generation analysis, continues to evolve and guide the management of these patients.
Abnormal coagulation testing in individuals with cirrhosis leads to a variety of difficult clinical scenarios that can be challenging for practitioners. With advanced liver disease, changes in the traditional tests of hemostasis such as the international normalized ratio reflect decreased synthesis of procoagulant factors but do not capture concomitant decreases in anticoagulant factors. In this setting, transfusion thresholds targeting platelet and fibrinogen goals may provide an effective strategy to optimize clot formation. Global tests of clot formation provide practical information to clinicians and can help guide decision making, although optimal target levels have not been validated.
本文旨在为临床医生提供肝脏疾病患者凝血检测概述，讨论可用的促凝剂及其使用依据，并提供多种常见临床情况下的管理策略。
临床医生和研究人员越来越了解使用传统凝血检测评估出血风险的局限性。包括黏弹性检测和凝血酶生成分析在内的整体凝血形成检测的应用不断发展并指导这些患者的管理。
肝硬化患者的凝血检测异常导致各种临床情况复杂，给临床医生带来挑战。随着肝脏疾病的进展，国际标准化比值等传统止血检测的变化反映了促凝因子合成减少，但不能捕捉同时发生的抗凝因子减少。在这种情况下，针对血小板和纤维蛋白原目标的输血阈值可能是优化凝血形成的有效策略。整体凝血形成检测为临床医生提供了实用信息，并有助于指导决策，尽管尚未验证最佳目标水平。
