Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2015; 21(35): 10062-10071
Published online Sep 21, 2015. doi: 10.3748/wjg.v21.i35.10062
Coagulopathy in liver disease: Lack of an assessment tool
Annabel Blasi
Annabel Blasi, Anesthesia Department, Hospital Clínic, Institut d´investigacions Biomediques Agustí Pi i Sunyer, 08037 Barcelona, Spain
Author contributions: Blasi A solely contributed to this work.
Conflict-of-interest statement: The author declares no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Annabel Blasi, MD, Anesthesia Department, Hospital Clínic, Institut d´investigacions Biomediques Agustí Pi i Sunyer, 08037 Barcelona, Spain. annnabelb@gmail.com
Telephone: +34-932-275558 Fax: +34-932-279184
Received: April 6, 2015
Peer-review started: April 7, 2015
First decision: May 18, 2015
Revised: May 29, 2015
Accepted: August 25, 2015
Article in press: August 25, 2015
Published online: September 21, 2015
Abstract

There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrepancy leads us to rely on other variables which have been shown to be involved in haemostasis in these patients and/or to extrapolate the behaviour of these patients to other settings in order to decide the best clinical approach. The aims of the present review are as follows: (1) to present the information provided by clotting tests in cirrhotic patients; (2) to present the factors that may influence clotting in these patients; (3) to review the clinical evidence; and (4) to put forward a clinical approach based on the first 3 points.

Keywords: Cirrhosis, Coagulation test, Assessment, Coagulopathy, Bleeding, Thrombosis

Core tip: The lack of comprehensive tests to assess coagulopathy in liver disease ties the management of this disease to the clinical evidence. This review considers the information provided by clotting tests in cirrhotic patients, identifies clinical evidence on which to base the management of the disease, and considers possible future directions of research.