Viscoelastic Testing for Hemostatic Assessment in Liver Transplantation
- 1Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32608, USA
Abstract
Background/Objectives: End-stage liver disease leads to a unique coagulation profile. This rebalanced coagulation status is characterized by the propensity to bleed easily and form clots in blood vessels. Managing these patients requires close monitoring and an understanding of the underlying pathophysiology. Decreased production of coagulation factors by the liver and splenic sequestration of platelets lead to conditions favoring a hypocoagulable picture. Increased levels of factor VIII and von Willebrand factor along with decreased production of anticlotting factors lead to an environment favoring thrombosis. Viscoelastic testing allows clinicians to navigate this challenging coagulation scenario and preserve the delicate balance. Methods: We review recent technological advancements in coagulation monitoring during liver transplantation. Viscoelastic testing has been used and validated in liver transplantation initially using mechanical methods for assessing clot formation and strength, but newer viscoelastic testing platforms are transitioning toward resonance-based technologies and cartridge-based point-of-care devices that allow for faster assessment of coagulopathies. Development of faster point-of-care devices is beneficial for liver transplantation given acute coagulopathies that can occur throughout phases of the case. Results/Conclusions: This paper will discuss briefly transfusion thresholds; how the SEER-based Quantra, resonance-based TEG 6s, and automated cartridge-based ROTEM SIGMA work; gaps using conventional coagulation testing; and the integration of these systems into perioperative decision making to support goal-directed transfusion strategies.
Related
- Viscoelastic Hemostatic Testing as a Diagnostic Tool for Trauma-Induced Coagulopathy with a Focus on Arabian Gulf Countries: A Narrative Review
- Viscoelastic Testing for Assessment of Hypercoagulability and Thrombotic Risk in Cancer Patients: A Systematic Review
- CO055 | COMPARISON OF VISCOELASTIC COAGULATION MONITOR AND ROTATIONAL THROMBOELASTOMETRY FOR HEMOSTATIC PHENOTYPING AND OUTCOME PREDICTION IN SEPSIS
- Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS): Assessment & validation of imaging modality performance across the NAFLD spectrum in a prospectively recruited cohort study (the LITMUS imaging study): Study protocol
- Viscoelastic haemostatic assay-guided transfusion versus conventional coagulation testing in critically ill non-cardiac adults with active bleeding or clinically significant coagulopathy: protocol for a systematic review and meta-analysis
BibTeX
@article{bashir2026viscoelastic,
title = {{Viscoelastic Testing for Hemostatic Assessment in Liver Transplantation}},
author = {Asad H. Bashir and Chris Giordano and Meghan Brennan},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207873},
url = {https://www.mdpi.com/2077-0383/15/20/7873},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Viscoelastic Testing for Hemostatic Assessment in Liver Transplantation
AU - Asad H. Bashir
AU - Chris Giordano
AU - Meghan Brennan
PY - 2026
DA - 2026/10/13
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207873
UR - https://www.mdpi.com/2077-0383/15/20/7873
AB - Background/Objectives: End-stage liver disease leads to a unique coagulation profile. This rebalanced coagulation status is characterized by the propensity to bleed easily and form clots in blood vessels. Managing these patients requires close monitoring and an understanding of the underlying pathophysiology. Decreased production of coagulation factors by the liver and splenic sequestration of platelets lead to conditions favoring a hypocoagulable picture. Increased levels of factor VIII and von Willebrand factor along with decreased production of anticlotting factors lead to an environment favoring thrombosis. Viscoelastic testing allows clinicians to navigate this challenging coagulation scenario and preserve the delicate balance. Methods: We review recent technological advancements in coagulation monitoring during liver transplantation. Viscoelastic testing has been used and validated in liver transplantation initially using mechanical methods for assessing clot formation and strength, but newer viscoelastic testing platforms are transitioning toward resonance-based technologies and cartridge-based point-of-care devices that allow for faster assessment of coagulopathies. Development of faster point-of-care devices is beneficial for liver transplantation given acute coagulopathies that can occur throughout phases of the case. Results/Conclusions: This paper will discuss briefly transfusion thresholds; how the SEER-based Quantra, resonance-based TEG 6s, and automated cartridge-based ROTEM SIGMA work; gaps using conventional coagulation testing; and the integration of these systems into perioperative decision making to support goal-directed transfusion strategies.
SN - 2077-0383
ER -