Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care.

Coagulopathy and hemostasis management in patients undergoing liver transplantation: Defining a dynamic spectrum across phases of care.
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接受肝移植的患者的凝血病和止血管理:定义跨护理阶段的动态谱。

DOI:
10.1002/lt.26451
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发表时间:
2022-10
影响因子:
4.6
通讯作者:
Intagliata, Nicolas
Intagliata, Nicolas
中科院分区:
医学2区
文献类型:
--
作者:
Pillai, Anjana A.;Kriss, Michael;Al-Adra, David P.;Chadha, Ryan M.;Cushing, Melissa M.;Farsad, Khashayar;Fortune, Brett E.;Hess, Aaron S.;Lewandowski, Robert;Nadim, Mitra K.;Nydam, Trevor;Sharma, Pratima;Karvellas, Constantine J.;Intagliata, Nicolas

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急性和慢性肝病患者存在广泛的疾病状态和严重程度,可能需要肝移植(LT)。在围手术期护理的所有阶段,生理变化都是动态的,从而产生了复杂的管理方案,需要多学科的临床护理。具体而言,肝病中止血的改变可以随着时间的推移而明显并随着疾病进展而演变。最近的研究和社会指南解决了这一新兴的范例,并提供了协助肝病患者止血管理的建议。然而,接受LT的患者是独特和多样化的,通常患有不稳定的疾病,需要专门的方法。我们的目的是提供一个集中的审查LT患者的止血管理,区分护理的三个主要阶段(LT前,围手术期,LT后)的独特方面,并确定知识差距和未来研究的关键领域。
Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies and society guidance address this emerging paradigm and offer recommendations to assist with hemostatic management in patients with liver disease. However, patients undergoing LT are unique and diverse, often with unstable disease that requires specialized approaches. Our aim is to provide a focused review of hemostatic management of the LT patient, distinguish unique aspects of the three main phases of care (before LT, perioperative, and after LT), and identify knowledge gaps and critical areas of future research.
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