The prothrombin time and international normalised ratio are used in scoring systems in chronic liver disease and as a prognostic tool, and for dynamic monitoring of hepatic function in acute liver disease.
These tests are known to be poor predictors of bleeding risk in liver disease; however, they continue to influence clinical management decisions.
Dr Susan Mallett and colleagues from the United Kingdom performed a systematic review of all relevant studies that have used viscoelastic tests of coagulation in patients with liver disease.
Recent work on coagulation in liver disease, in particular thrombin generation studies, has led to a paradigm shift in our understanding and it is now recognised that haemostasis is relatively well preserved.
|Viscoelastic tests provide more clinically relevant information in patients with liver disease|
The research team report that whole blood global viscoelastic tests (TEG®/ROTEM®) produce a composite dynamic picture of the entire coagulation process, and have the potential to provide more clinically relevant information in patients with liver disease.
Dr Mallet's team concludes, "Although many studies are observational and small in size, it is clear that viscoelastic tests provide additional information that is in keeping with the new concepts of how coagulation is altered in these patients."
"This review provides the basis for large scale, prospective outcome studies to establish the clinical value of these tests."