Viscoelastic tests in liver disease: where do we stand now?

Figure 1 Rebalanced hemostasis in liver cirrhosis. In primary hemostasis, high levels of von Willebrand factor and low levels of disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 counteract numerical or functional abnormalities of platelets. In the coagulation phase, low levels of procoagulant proteins are balanced by reduced synthesis of anticoagulant factors. In fibrinolysis, parallel changes are seen in profibrinolytic and antifibrinolytic proteins. The balance is though fragile, and various factors, as inflammation, infection, uremia may unstable it, leading to bleeding or thrombosis. tPA: Tissue plasminogen activator; TAFI: Thrombin-activatable fibrinolysis inhibitor; vWF: von Willebrand factor; ADAMTS13: Disintegrin and metalloproteinase with a thrombospondin type 1 motif 13; PAI-1: Plasminogen activator inhibitor-1.