Education  |   February 2017
Value of Preoperative Hemostasis Testing in Patients with Liver Disease for Perioperative Hemostatic Management
Author Notes
  • From the Section of Hepatobiliairy Surgery and Liver Transplantation (T.L., R.J.P.) and Surgical Research Laboratory (T.L.), Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.
    Figures 1 and 2 were enhanced by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.×
  • Submitted for publication April 27, 2016. Accepted for publication October 6, 2016.
    Submitted for publication April 27, 2016. Accepted for publication October 6, 2016.×
  • Address correspondence to Dr. Lisman: Department of Surgery, University Medical Center Groningen, BA33, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. j.a.lisman@umcg.nl. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Clinical Concepts and Commentary / Coagulation and Transfusion / Gastrointestinal and Hepatic Systems / Hematologic System
Education   |   February 2017
Value of Preoperative Hemostasis Testing in Patients with Liver Disease for Perioperative Hemostatic Management
Anesthesiology 2 2017, Vol.126, 338-344. doi:10.1097/ALN.0000000000001467
Anesthesiology 2 2017, Vol.126, 338-344. doi:10.1097/ALN.0000000000001467
DURING the preoperative workup of any patient undergoing moderate to major invasive surgery, an assessment of bleeding risk may be performed, but the role of laboratory testing is controversial.
The United Kingdom National Institute for Health and Care Excellence (NICE) recommends consideration of laboratory tests of hemostasis in selected patients undergoing moderate or severe surgery and with an American Society of Anesthesiologists (ASA) physical status classification system score of 3 or 4.1  The guideline specifically states to consider preoperative hemostasis testing in patients with chronic liver disease and ASA score of 3 or 4. The Practice Advisory for Preanesthesia Evaluation by the ASA2  states that “clinical characteristics to consider for ordering selected coagulation studies include bleeding disorders, renal dysfunction, liver dysfunction, and type and invasiveness of procedure.” Routine preoperative hemostasis testing may include platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen levels, although the NICE guidelines specifically refer to PT and aPTT testing only.
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