How to assess hemostasis in patients with severe liver disease

Patients with advanced liver dis eases fre quently acquire pro found alter ations in their hemo static sys tem. Simultaneous changes in procoagulant and anti co ag u lant sys tems result in a reset in the hemo static bal ance with a rel a tively neu tral net effect, although there are nota ble hypocoagulable and hyper co ag u la ble fea tures in the hemo static sys tem in patients with liver dis ease. Laboratory and clin i cal stud ies have dem on strated that patients have a rel a tively well- pre served hemo static sys tem even though rou tine diag nos tic tests of hemo sta sis (pro throm bin time, plate let count) sug gest a bleed ing ten dency. Routine diag nos tic tests of hemo sta sis are unsuit able to assess the hemo static sta tus of patients with liver dis ease, as these tests are insen si tive for the con cur rent prohemostatic and antihemostatic changes in these patients. These tests are, how ever, fre quently requested in patients with liver dis ease, as they are well established indi ca tors of sever ity of liver dis ease. This paper will dis cuss com monly used diag nos tic and research- type hemo static tests and will out line how test results should be interpreted in patients with liver dis ease.