Review article: thromboelastography in liver diseases

• Published in: Alimentary pharmacology & therapeutics Vol. 56; no. 4; pp. 580 - 591
• Main Authors: He, Yanglan, Yao, Haijuan, Ageno, Walter, Méndez‐Sánchez, Nahum, Guo, Xiaozhong, Qi, Xingshun
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.08.2022
• Subjects: Bleeding; Blood products; Blood transfusion; Liver diseases; Patients; Prothrombin; Thromboembolism; Thrombosis; Viscoelasticity
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.17080

Summary Background Patients with liver diseases have complicated haemostatic alternations, resulting in both bleeding and thromboembolic complications, which cannot be sufficiently evaluated by conventional coagulation tests (CCTs), such as platelet count or prothrombin time. Thromboelastography (TEG) is a whole blood viscoelastic test which globally reflects changes in the haemostatic system, and its utility in evaluating patients with liver disease is increasingly recognised. Aims To review the current evidence and clinical significance of TEG in liver diseases. Methods Literature regarding TEG and liver diseases was comprehensively searched. Results TEG is associated closely with the severity and aetiology of liver disease, the course of infection and the risk of bleeding and death, but not the risk of portal venous system thrombosis. Additionally, TEG‐guided transfusion protocols can significantly decrease the requirement for blood products compared to those guided by CCTs. Conclusion TEG can reflect the haemostatic status of liver diseases more comprehensively than CCTs. It has the potential to assess the severity of liver diseases, predict the risk of bleeding and death in patients with liver disease and guide blood product transfusion. Future studies should standardise the use of TEG for assessing disease severity and development of clinical events and guiding blood product transfusion in patients with liver diseases. Physiological haemostasis includes primary haemostasis, coagulation cascade, and fibrinolysis, which can be comprehensively reflected by thromboelastography (TEG) test, but not conventional coagulation tests (CCTs). Hypercoagulable and hypocoagulable state can be evaluated by the results of various TEG parameters. There are several factors associated with hypercoagulable and hypocoagulable TEG profile based on the current evidence. Currently, the management of hypercoagulable state indicated by TEG profile is not clear, and TEG guided transfusion protocol has been proposed for the management of hypocoagulable state reflected by the results of various TEG parameters.