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Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease

Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patien...

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Autores principales: Tomić Mahečić, Tina, Baronica, Robert, Mrzljak, Anna, Boban, Ana, Hanžek, Ivona, Karmelić, Dora, Babić, Anđela, Mihaljević, Slobodan, Meier, Jens
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777026/
https://www.ncbi.nlm.nih.gov/pubmed/36553179
http://dx.doi.org/10.3390/diagnostics12123172
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author Tomić Mahečić, Tina
Baronica, Robert
Mrzljak, Anna
Boban, Ana
Hanžek, Ivona
Karmelić, Dora
Babić, Anđela
Mihaljević, Slobodan
Meier, Jens
author_facet Tomić Mahečić, Tina
Baronica, Robert
Mrzljak, Anna
Boban, Ana
Hanžek, Ivona
Karmelić, Dora
Babić, Anđela
Mihaljević, Slobodan
Meier, Jens
author_sort Tomić Mahečić, Tina
collection PubMed
description Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patient population. Despite deranged quantitative and qualitative coagulation laboratory parameters, prophylactic coagulation management is unnecessary for patients who do not bleed. Transfusion of red blood cells (RBCs) and blood products carries independent risks for morbidity and mortality, including modulation of the immune system with increased risk for nosocomial infections. Optimal coagulation management in these complex patients should be based on the analysis of standard coagulation tests (SCTs) and viscoelastic tests (VETs). VETs represent an individualized approach to patients and can provide information about coagulation dynamics in a concise period of time. This narrative review will deliver the pathophysiology of deranged hemostasis in ESLD, explore the difficulties of evaluating the coagulopathies in liver disease patients, and examine the use of VET assays and management of coagulopathy using coagulation factors. Methods: A selective literature search with PubMed as the central database was performed with the following.
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spelling pubmed-97770262022-12-23 Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease Tomić Mahečić, Tina Baronica, Robert Mrzljak, Anna Boban, Ana Hanžek, Ivona Karmelić, Dora Babić, Anđela Mihaljević, Slobodan Meier, Jens Diagnostics (Basel) Review Over the last decades, individualized approaches and a better understanding of coagulopathy complexity in end-stage liver disease (ESLD) patients has evolved. The risk of both thrombosis and bleeding during minimally invasive interventions or surgery is associated with a worse outcome in this patient population. Despite deranged quantitative and qualitative coagulation laboratory parameters, prophylactic coagulation management is unnecessary for patients who do not bleed. Transfusion of red blood cells (RBCs) and blood products carries independent risks for morbidity and mortality, including modulation of the immune system with increased risk for nosocomial infections. Optimal coagulation management in these complex patients should be based on the analysis of standard coagulation tests (SCTs) and viscoelastic tests (VETs). VETs represent an individualized approach to patients and can provide information about coagulation dynamics in a concise period of time. This narrative review will deliver the pathophysiology of deranged hemostasis in ESLD, explore the difficulties of evaluating the coagulopathies in liver disease patients, and examine the use of VET assays and management of coagulopathy using coagulation factors. Methods: A selective literature search with PubMed as the central database was performed with the following. MDPI 2022-12-15 /pmc/articles/PMC9777026/ /pubmed/36553179 http://dx.doi.org/10.3390/diagnostics12123172 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Tomić Mahečić, Tina
Baronica, Robert
Mrzljak, Anna
Boban, Ana
Hanžek, Ivona
Karmelić, Dora
Babić, Anđela
Mihaljević, Slobodan
Meier, Jens
Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
title Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
title_full Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
title_fullStr Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
title_full_unstemmed Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
title_short Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease
title_sort individualized management of coagulopathy in patients with end-stage liver disease
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777026/
https://www.ncbi.nlm.nih.gov/pubmed/36553179
http://dx.doi.org/10.3390/diagnostics12123172
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