Why the study?
Traditional beliefs assumed chronic liver disease caused major bleeding risks, but newer evidence shows patients may maintain hemostatic balance, prompting an updated overview of perioperative coagulation management.
This position paper updates traditional beliefs about bleeding risk in cirrhotic patients, emphasizing that they may be in hemostatic balance and requiring sophisticated monitoring during perioperative management.
Cirrhosis signals higher perioperative complication and mortality risks; leaves open targeted mitigation strategies.
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.
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Biancofiore et al. (2019) conducted a review in Cirrhosis. Perioperative hemostatic management was evaluated. This position paper outlines perioperative coagulation management in cirrhotic patients, who face a 47% increased risk of postoperative complications and >2.5-fold higher in-hospital mortality.
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