Perioperative hemostatic management in the cirrhotic patient: a position paper on behalf of the Liver Intensive Care Group of Europe (LICAGE)

Gianni Biancofiore*, Annabel Blasi, Marieke T. De Boer, Massimo Franchini, Matthias Hartmann, Ton Lisman, Giancarlo M. Liumbruno, Robert J. Porte, Fuat Saner, Marco Senzolo, Maureen J. Werner

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)

Abstract

Recent data demonstrated that amongst patients undergoing elective surgery the prevalence of cirrhosis is 0.8% equating to approximately 25 million cirrhotic patients undergoing surgery each year worldwide. Overall. the presence of cirrhosis is independently associated with 47% increased risk of postoperative complications and over two and a half-increased risk of in-hospital mortality in patients undergoing elective surgery. In particular, perioperative patients with chronic liver disease have long been assumed to have a major bleeding risk on the basis of abnormal results for standard tests of hemostasis. However, recent evidence outlined significant changes to traditional knowledge and beliefs and, nowadays, with more sophisticated laboratory tests, it has been shown that patients with chronic liver disease may be in hemostatic balance as a result of concomitant changes in both pro- and antihemostatic pathways. The aim of this paper endorsed by the Liver Intensive Care Group of Europe was to provide an up-to-date overview of coagulation management in perioperative patients with chronic liver disease focusing on patient blood management, monitoring of hemostasis, and current role of hemostatic agents.

Original languageEnglish
Pages (from-to)782-798
Number of pages17
JournalMinerva anestesiologica
Volume85
Issue number7
DOIs
Publication statusPublished - Jul-2019

Keywords

  • Liver cirrhosis
  • Hemostasis
  • Blood coagulation disorders
  • Perioperative care
  • PORTAL-VEIN THROMBOSIS
  • HEPATIC-ARTERY THROMBOSIS
  • CRITICALLY-ILL PATIENTS
  • CENTRAL VENOUS-PRESSURE
  • FRESH-FROZEN PLASMA
  • RECOMBINANT-FACTOR-VIIA
  • BLOOD-CELL TRANSFUSION
  • VON-WILLEBRAND-FACTOR
  • ACTIVATED FACTOR-VII
  • RISK-FACTORS

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