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Minerva Anestesiologica 2019 July;85(7):782-98

DOI: 10.23736/S0375-9393.19.13468-2


lingua: Inglese

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

Gianni BIANCOFIORE 1 , Annabel BLASI 2, Marieke T. DE BOER 3, Massimo FRANCHINI 4, Matthias HARTMANN 5, Ton LISMAN 3, Giancarlo M. LIUMBRUNO 6, Robert J. PORTE 3, Fuat SANER 7, Marco SENZOLO 8, Maureen J. WERNER 3

1 Department of Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy; 2 Department of Anesthesia, Hospital Clinic, Barcelona, Spain; 3 Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 4 Department of Hematology and Transfusion Medicine, Hospital of Mantua, Mantua, Italy; 5 Department of Anesthesiology and Critical Care, University of Duisburg-Essen, Duisburg, Germany; 6 Italian National Blood Center, National Institute of Health, Rome, Italy; 7 Department of General-, Visceral- and Transplant Surgery, University Duisburg-Essen, Duisburg, Germany; 8 Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

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.

KEY WORDS: Liver cirrhosis; Hemostasis; Blood coagulation disorders; Perioperative care

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