Department of Hematology, Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris 75012, France.
Department of Hematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris 75013, France.
World J Gastroenterol. 2021 Nov 14;27(42):7285-7298. doi: 10.3748/wjg.v27.i42.7285.
Due to concomitant changes in pro- and anti-coagulant mechanisms, patients with liver dysfunction have a "rebalanced hemostasis", which can easily be tipped toward either a hypo- or a hypercoagulable phenotype. Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities. Conventional coagulation screening tests, such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures. The introduction of global coagulation assays, such as viscoelastic testing (VET), has been an important step forward in the assessment of the overall hemostasis profile. A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings. The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.
由于促凝和抗凝机制的同时改变，肝功能障碍的患者会出现“重新平衡的止血”，这很容易导致低凝或高凝表型。临床医生经常面临这样的问题：接受有创操作或手术的慢性肝病患者以及有活动性出血的患者是否需要纠正止血异常。常规凝血筛选试验，如凝血酶原时间/国际标准化比值和活化部分凝血活酶时间，已被证明在这些患者中有许多局限性，不能预测高风险操作前出血的风险。引入了整体凝血检测，如粘弹性检测（VET），这是评估整体止血特征的重要一步。越来越多的证据表明，VET 的使用可能具有重要的临床实用价值，可以防止不必要的血液制品输注，并改善许多情况下的结局。本综述讨论了常规和整体凝血检测评估慢性肝病患者出血风险的优缺点，以及目前输血和止血药物预防或管理出血的作用。
