Misguided by INR in Liver Disease Patients? Implications for Clinicians Including Pain Proceduralists

Adult liver transplant anesthesiology practice patterns and resource utilization in the United States: Survey results from the society for the advancement of transplant anesthesia

“…The almost universal use of point of care viscoelastic testing in respondents reflects the complex manifestations and rebalance of anti‐ and pro‐coagulation changes seen in patients presenting for liver transplantation 11 . Dynamic hemostatic changes during this operation are not well measured by isolated, standardized plasma‐based laboratory coagulation assays 12 . Use of either the TEG or ROTEM systems in patients undergoing transplantation are well described, initially in non‐randomized reports, with fewer prospective level 1 data.…”

“…11 Dynamic hemostatic changes during this operation are not well measured by isolated, standardized plasma-based laboratory coagulation assays. 12 Use of either the TEG or ROTEM systems in patients undergoing transplantation are well described, initially in non-randomized reports, with fewer prospective level 1 data. Meta-analyses are dominated by reports in cardiac surgery and include patients with liver disease undergoing non-transplant procedures.…”

Coagulopathy and hemorrhage management in cirrhotic patients

“…I test Point of Care (POC), come TEG® o ROTEM®, che valutano le caratteristiche viscoelastiche del sangue, consentono di avere a disposizione un profilo realistico e dinamico della competenza emostatica del singolo malato e pertanto, piuttosto che i test di laboratorio standard, questi strumenti dovrebbero essere usati come riferimento nella gestione dell'emostasi nei pazienti cirrotici chirurgici (7,9,10,17,(22)(23)(24)(25)(26).…”

“…L'INR è stato ideato e convalidato solo per i pazienti in trattamento con farmaci anti vitamina K (VKA). L'INR si dimostra poco affidabile anche a causa di una variabilità sia intra-laboratorio che inter-laboratorio (10,11).…”