ReviewWorld journal of gastroenterology2021
Viscoelastic tests in liver disease: where do we stand now?
Review in World journal of gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 29 citations in OpenAlex.
- Critical care hepatology: A narrative review of current concepts and management.World journal of critical care medicine · 2026Review
- Comparing Rotational Thromboelastometry and Standard Coagulation Assays for Predicting Intraoperative Bleeding in Pediatric Liver Transplantation.Pediatric transplantation · 2026Article
- Rotational Thromboelastometry (ROTEM) Versus Conventional Coagulation Tests in Cirrhosis: Can We Reduce Plasma Transfusion Without ROTEM?Journal of clinical laboratory analysis · 2025Article
- A Review of Desmopressin Use in Bleeding Disorders: An Unsung Hero?Biomolecules · 2025Review
- Article
- The Bleeding Edge: Managing Coagulation and Bleeding Risk in Patients with Cirrhosis Undergoing Interventional Procedures.Diagnostics (Basel, Switzerland) · 2024Review
- Cirrhosis Progression Is Not Associated with Clinically Significant Alterations in Global Hemostasis Assessed by Thromboelastography.Journal of clinical medicine · 2024Article
- Autoimmune Hepatitis Complicated by Undiagnosed Factor VII Deficiency: A Pitfall of Coagulopathy.Internal medicine (Tokyo, Japan) · 2024Article
- The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?Journal of clinical medicine · 2024Review
- Surgical risk stratification in patients with cirrhosis.Hepatology international · 2024Review
- Article
- Approach to thromboelastography-based transfusion in cirrhosis: An alternative perspective on coagulation disorders.World journal of gastroenterology · 2023Review
- New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management.Life (Basel, Switzerland) · 2022Review
- Individualized Management of Coagulopathy in Patients with End-Stage Liver Disease.Diagnostics (Basel, Switzerland) · 2022Review
- Stroke, Thrombosis, Bleeding and Addiction to Anticoagulants in the Context of Course Therapy: A Pharmacologic Perspective.Reviews in cardiovascular medicine · 2022Article
- Study on Deep Vein Thrombosis Incidence and Risk Factors in Orthopedic Trauma Patients with Chronic Hepatitis B: 579 Cases Analyzed.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
- Rotational Thromboelastometry and Bleeding Risk in Child-Pugh C Cirrhosis: Methodological Considerations.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
- The Predictive Value of the Rotational Thromboelastometry for Bleeding Risk in Patients With Child-Pugh Class C Cirrhosis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hemostasis is a complex physiological process based on the balance between pro-coagulant and anticoagulant systems to avoid pathological bleeding or thrombosis. The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder, and cirrhotic patients were considered naturally anticoagulated. In the light of the new evidence, the theory of rebalanced hemostasis replaced the old concept. According to this model, the hemostatic alteration leads to a unique balance between pro-coagulant, anticoagulant, and fibrinolytic systems. But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors. The standard coagulation tests [INR (international normalized ratio), platelet count and fibrinogen] only explore parts of the hemostasis, not offering an entire image of the process. Rotational thromboelastometry (ROTEM) and thromboelastography (TEG) are both point of care viscoelastic tests (VET) that provide real-time and dynamic information about the entire hemostasis process, including clot initiation (thrombin generation), clot kinetics, clot strength, and clot stability (lysis). Despite prolonged PT/INR (international normalized ratio of prothrombin time) and low platelet counts, VET is within the normal range in many patients with both acute and chronic liver disease. However, bleeding remains the dominant clinical issue in patients with liver diseases, especially when invasive interventions are required. VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests, leading to decrial use of blood products transfusion. Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET. Although VET has shown its benefit, more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.