Viscoelastic haemostatic test based management of coagulopathy in liver transplantation for cirrhosis

Abstract

Management of coagulopathy is an important consideration in the management of liver transplantation (LT) for end stage liver disease due to cirrhosis. Blood loss and the volume of blood products transfused are key determinants of outcome following liver transplantation. Cirrhosis has traditionally been associated with hypocoagulability and haemorrhage. Greater understanding of the normal haemostatic processes and the derangement associated with cirrhosis has resulted in the concept of rebalanced haemostasis in cirrhosis. This rebalancing and reduction of haemostatic reserves results in an unpredictable and often pro thrombotic haemostatic state in cirrhosis. The predictive value of standard tests of coagulation is diminished in cirrhosis. In contrast, viscoelastic haemostatic tests have demonstrated superior diagnostic and bleeding predicting capabilities in cirrhosis. Bleeding management protocols including viscoelastic haemostatic test-based algorithms have reduced transfusion requirements without an increase in the incidence of bleeding or thrombotic complications in liver transplantation.