ArticleHPB : the official journal of the International Hepato Pancreato Biliary Association2009
How to minimize blood loss during liver surgery in patients with cirrhosis.
Article in HPB : the official journal of the International Hepato Pancreato Biliary Association, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Specific Items of Enhanced Recovery After Surgery for Liver Surgery in Cirrhotic Patients: A Systematic Review.World journal of surgery · 2025Pooled it
- Guideline
- Laparoscopic and open minor liver resection for hepatocellular carcinoma with clinically significant portal hypertension: a multicenter study using inverse probability weighting approach.Surgical endoscopy · 2024Article
- Total Hip Arthroplasty in Cirrhosis is Associated with Increased Complications during the Hospital Stay, Length of Stay, and Cost of Care: A Propensity Matched Database Study.The archives of bone and joint surgery · 2023Article
- Impact of Platelet Count on Perioperative Bleeding in Patients With Cirrhosis Undergoing Surgical Treatments of Liver Cancer.Hepatology communications · 2022Article
- Histopathological effects of Algan hemostatic agent (AHA) in liver injury model in rats.Hepatology forum · 2022Article
- Possible roles of platelets in liver transplantation: regeneration and cancer recurrence.Anesthesia and pain medicine · 2021Review
- Article
- Efficacy of pro- and anticoagulant strategies in plasma of patients undergoing hepatobiliary surgery.Journal of thrombosis and haemostasis : JTH · 2020Article
- Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients.Transplantation · 2018Article
- Fibrinolytic System Changes in Liver Surgery: A Pilot Observational Study.Frontiers in medicine · 2018Article
- Pathogenesis, prevention, and management of bleeding and thrombosis in patients with liver diseases.Research and practice in thrombosis and haemostasis · 2017Review
- K time & maximum amplitude of thromboelastogram predict post-central venous cannulation bleeding in patients with cirrhosis: A pilot study.The Indian journal of medical research · 2017Article
- Decreased prothrombin conversion and reduced thrombin inactivation explain rebalanced thrombin generation in liver cirrhosis.PloS one · 2017Article
- Viscoelastic testing for hepatic surgery: a systematic review with meta-analysis-a protocol.Systematic reviews · 2016Article
- Is low central venous pressure effective for postoperative care after liver transplantation?Surgery today · 2013Article
- Medical and endoscopic management of gastric varices.Seminars in interventional radiology · 2011Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Patients with liver disease frequently have substantial changes in their haemostatic system. This is reflected in abnormal test results on routine coagulation screening assays such as the prothrombin time (PT), activated thromboplastin time (APTT) and platelet count. Traditionally, attempts were made to correct abnormalities in the haemostatic system as measured by routine coagulation assays prior to invasive procedures by infusion of platelets or fresh frozen plasma (FFP). Recent laboratory and clinical data have indicated that the haemostatic reserve in cirrhotic patients is relatively well maintained although the coagulation screening assays suggest otherwise. Pre-procedural correction of coagulation tests with blood products may therefore not be necessary, and may even have harmful side-effects. In particular, fluid overload resulting in exacerbation of portal hypertension by infusion of blood products may in fact promote bleeding. In recent years, it has become clear that reduction of the central and portal venous pressure by fluid restriction and avoidance of blood product transfusion is a beneficial strategy in minimizing bleeding during liver surgery in cirrhotic patients. Some investigators have even taken this a step further and suggested pre-procedural phlebotomy in liver transplant recipients. The aim of this review is to provide an overview of recent studies and developments which have changed our understanding of the clinical relevance of abnormal coagulation tests in patients with cirrhosis, and which have contributed to a reduction in blood loss and transfusion requirements when liver surgery is needed in these patients.
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