Clinical utility of viscoelastic testing in chronic liver disease: A systematic review  

作　　者：Henry Wei Lauren Jane Child 

机构地区：[1]Department of Gastroenterology and Hepatology,Middlemore Hospital,Auckland 1071,New Zealand [2]Department of Haematology,New Zealand Blood Services Epsom,Auckland 1051,New Zealand

出　　处：《World Journal of Hepatology》2020年第11期1115-1127,共13页世界肝病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Conventional coagulation tests are widely used in chronic liver disease to assess haemostasis and to guide blood product transfusion.This is despite the fact that conventional tests do not reliably separate those with a clinically significant coagulopathy from those who do not.Viscoelastic testing such as thromboelastography(TEG)correlate with bleeding risk and are more accurate in identifying those who will benefit from blood product transfusion.Despite this,viscoelastic tests have not been widely used in patients with chronic liver disease outside the transplant setting.AIM To assess the utility of Viscoelastic Testing guided transfusion in chronic liver disease patients presenting with bleeding or who require an invasive procedure.METHODS PubMed and Google Scholar searches were performed using the key words“thromboelastography”,“TEG”or“viscoelastic”and“liver transplantation”,“cirrhosis”or“liver disease”and“transfusion”,“haemostasis”,“blood management”or“haemorrhage”.A full text review was undertaken and data was extracted from randomised control trials that evaluated the outcomes of viscoelastic test guided transfusion in those with liver disease.The study subjects,inclusion and exclusion criteria,methods,outcomes and length of follow up were examined.Data was extracted by two independent individuals using a standardized collection form.The risk of bias was assessed in the included studies.RESULTS A total of five randomised control trials included in the analysis examined the use of TEG guided blood product transfusion in cirrhosis prior to invasive procedures(n=118),non-variceal haemorrhage(n=96),variceal haemorrhage(n=60)and liver transplantation(n=28).TEG guided transfusion was effective in all five studies with a statistically significant reduction in overall blood product transfusion compared to standard of care.Four of the five studies reported a significant reduction in transfusion of fresh frozen plasma and platelets.Two studies showed a significant re

关 键 词：Viscoelastic testing THROMBOELASTOGRAPHY Rotational thrombelastometry COAGULATION Chronic liver disease End stage liver disease CIRRHOSIS HAEMOSTASIS 

分 类 号：R575[医药卫生—消化系统]