Hemostasis in liver transplantation: Pathophysiology, monitoring, and treatment

Figure 1 Pathophysiology of hemostasis in patients presenting for liver transplantation. A reduction in coagulation factors due to end stage liver disease worsens clot quality. Decreases in anticoagulant factors, fibrinolysis and ADAMTS 13 as well as increases in tissue factor and von Willebrand factor multimeres may favor disseminated intravascular coagulation. Shedding of glycocalyx induces a systemic anticoagulation and contributes to the procoagulatory shift of the endothelium. Note that pathophysiology may vary upon the underlying liver pathophysiology.