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Abstract：
UNASSIGNED: Standard coagulation tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio are determined by liver-synthesized coagulation factors. Despite an increased international normalized ratio, patients with cirrhosis are in a \"rebalanced\" state of hemostasis as the concomitant effect of reduced protein C, protein S, and thrombomodulin is not evaluated in standard coagulation tests. The cell-based model of hemostasis indicates additional mechanisms such as systemic inflammation, sepsis, and organ failures tip the delicate coagulation balance to an anticoagulant type in acute-on-chronic liver failure. In acute liver failure, thrombin generation and platelet function remain intact despite a marked prolongation in prothrombin time. We aimed to explain the principles, application, and utility of viscoelastic tests such as thromboelastography, rotational thromboelastometry, and Sonoclot.
UNASSIGNED: We reviewed the available literature from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trial with the search terms \'coagulation\', \'cirrhosis\', \'acute-on-chronic liver failure\', \'thromboelastography\', \'thromboelastometry\' and \'sonoclot\' for cross sectional studies, cohort studies and randomized trials.
UNASSIGNED: The point-of-care viscoelastic tests provide actionable targets for correcting the coagulation defect in a patient with bleeding and provide evidence-based algorithms for use in liver disease. A limitation of these tests is the inability to assess vessel injury and endothelial elements.
UNASSIGNED: Global coagulation tests provide a comprehensive estimate of coagulation in vitro; however, their use has only been validated in the setting of liver transplantation. Newer guidelines for hemostatic resuscitation are now accepting these POC tests, but additional data are required to validate their use as standard of care.
UNASSIGNED: We reviewed the available literature from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trial with the search terms \'coagulation\', \'cirrhosis\', \'acute-on-chronic liver failure\', \'thromboelastography\', \'thromboelastometry\' and \'sonoclot\' for cross sectional studies, cohort studies and randomized trials.
UNASSIGNED: The point-of-care viscoelastic tests provide actionable targets for correcting the coagulation defect in a patient with bleeding and provide evidence-based algorithms for use in liver disease. A limitation of these tests is the inability to assess vessel injury and endothelial elements.
UNASSIGNED: Global coagulation tests provide a comprehensive estimate of coagulation in vitro; however, their use has only been validated in the setting of liver transplantation. Newer guidelines for hemostatic resuscitation are now accepting these POC tests, but additional data are required to validate their use as standard of care.
摘要：
未经证实：标准凝血测试，如凝血酶原时间，活化部分凝血活酶时间，和国际标准化比率由肝脏合成的凝血因子确定。尽管国际标准化比率有所增加，肝硬化患者处于“再平衡”止血状态，作为蛋白C降低的伴随作用，蛋白质S，和血栓调节蛋白未在标准凝血试验中进行评估。基于细胞的止血模型表明了其他机制，如全身性炎症，脓毒症,和器官衰竭将微妙的凝血平衡提示为慢性急性肝衰竭的抗凝类型。在急性肝功能衰竭中，尽管凝血酶原时间明显延长,但凝血酶生成和血小板功能仍保持完整.我们旨在解释这些原则，应用程序,和粘弹性测试的实用性，如血栓弹力图，旋转血栓弹性测定法,还有Sonoclot.
未经评估：我们回顾了MEDLINE的现有文献，EMBASE和Cochrane对照试验中央登记册，搜索词为“凝血”，\'肝硬化\',“慢性急性肝衰竭”，\'血栓弹力图\',用于横断面研究的“血栓弹性测定法”和“超声心动图”，队列研究和随机试验。
UNASSIGNED：即时粘弹性测试为纠正出血患者的凝血缺陷提供了可行的目标，并提供了用于肝病的循证算法。这些测试的局限性是无法评估血管损伤和内皮素。
UNASSIGNED：全球凝血测试提供了体外凝血的全面估计；然而，它们的使用仅在肝移植的背景下得到验证。较新的止血复苏指南现在正在接受这些POC测试，但需要额外的数据来验证它们作为护理标准的使用。
未经评估：我们回顾了MEDLINE的现有文献，
UNASSIGNED：即时粘弹性测试为纠正出血患者的凝血缺陷提供了可行的目标，并提供了用于肝病的循证算法。
UNASSIGNED：全球凝血测试提供了体外凝血的全面估计；然而，
