Review article: thromboelastography in liver diseases

Abstract

Summary Background Patients with liver diseases have complicated haemostatic alternations, resulting in both bleeding and thromboembolic complications, which cannot be sufficiently evaluated by conventional coagulation tests (CCTs), such as platelet count or prothrombin time. Thromboelastography (TEG) is a whole blood viscoelastic test which globally reflects changes in the haemostatic system, and its utility in evaluating patients with liver disease is increasingly recognised. Aims To review the current evidence and clinical significance of TEG in liver diseases. Methods Literature regarding TEG and liver diseases was comprehensively searched. Results TEG is associated closely with the severity and aetiology of liver disease, the course of infection and the risk of bleeding and death, but not the risk of portal venous system thrombosis. Additionally, TEG‐guided transfusion protocols can significantly decrease the requirement for blood products compared to those guided by CCTs. Conclusion TEG can reflect the haemostatic status of liver diseases more comprehensively than CCTs. It has the potential to assess the severity of liver diseases, predict the risk of bleeding and death in patients with liver disease and guide blood product transfusion. Future studies should standardise the use of TEG for assessing disease severity and development of clinical events and guiding blood product transfusion in patients with liver diseases.

The Yin and the Yang of Hemostasis in End-Stage Liver Disease

“…He et al found that VET demonstrated normal coagulation status in stable cirrhotic patients and that hypercoagulability was not necessarily associated with the development of PVT [66]. Interestingly, in a meta-analysis performed one year later, the same group demonstrated the superiority of VET compared to SLTs in monitoring coagulation in patients with ESLD [67].…”

Application of thromboelastography to predict the severity of bleeding after chimeric antigen receptor (CAR)‐T cell therapy in patients with hematological malignancy

“…It is a complete and efficient approach for assessing coagulation function. Numerous studies have been published in the field highlighting the superior clinical utility of TEG in assessing coagulation status and forecasting bleeding risk compared to traditional coagulation tests 21–23 . TEG had a good predicting validity for the bleeding risk, according to a multi‐center prospective observational study of 267 sepsis patients in Europe 24 .…”

“…Numerous studies have been published in the field highlighting the superior clinical utility of TEG in assessing coagulation status and forecasting bleeding risk compared to traditional coagulation tests. [21][22][23] TEG had a good predicting validity for the bleeding risk, according to a multi-center prospective observational study of 267 sepsis patients in Europe. 24 This finding was in line with those of Pei et al and Guo, who both stated that TEG helped predict the occurrence of bleeding events.…”