Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2021; 27(42): 7285-7298
Published online Nov 14, 2021. doi: 10.3748/wjg.v27.i42.7285
Hemostasis testing in patients with liver dysfunction: Advantages and caveats
Guillaume Nguyen, Manon Lejeune, Benjamin Crichi, Corinne Frere
Guillaume Nguyen, Department of Hematology, Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris 75012, France
Manon Lejeune, Corinne Frere, Department of Hematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris 75013, France
Benjamin Crichi, Department of Internal Medicine, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris 75010, France
Corinne Frere, Inserm UMRS_1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris 75013, France
Author contributions: Nguyen G and Frere C performed the literature search, analyzed the data and wrote the paper; all authors contributed to editing, reviewing and final approval of manuscript.
Conflict-of-interest statement: Authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Corinne Frere, MD, PhD, Assistant Professor, Department of Hematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, Paris 75013, France.
Received: March 17, 2021
Peer-review started: March 17, 2021
First decision: May 1, 2021
Revised: May 8, 2021
Accepted: October 20, 2021
Article in press: October 20, 2021
Published online: November 14, 2021
Core Tip

Core Tip: Patients with liver dysfunction have a “rebalanced hemostasis” which can easily be tipped toward either a hypo- or a hypercoagulable phenotype. Clinicians are often faced with the question whether patients with liver dysfunction undergoing invasive procedures or surgery and those having active bleeding require correction of hemostasis abnormalities. While conventional coagulation screening tests have numerous limitations and do not predict the risk of bleeding prior to high-risk procedures or during surgery, a growing body of evidence suggests that viscoelastic testing might be of significant clinical utility in this setting. The present review discusses the advantages and caveats of both conventional and global coagulation assays in patients with chronic liver disease and the current role of hemostatic agents to prevent and manage bleeding.