Summary of how global diagnostic or research-type hemostasis tests should be interpreted in liver disease patients
| Laboratory test . | Sensitive for . | Does not assess . | Utility in liver disease . |
|---|---|---|---|
| Whole blood viscoelastic tests | Blood cells, coagulation proteins, fibrinolytic proteins. | VWF levels, protein C system, platelet function defects, role of flow in clot formation. | Better representation of hemostatic capacity compared to routine diagnostic tests, reduces blood product use, likely underestimates hemostatic capacity. |
| Platelet function tests | Platelet function, most tests also for platelet count. | Interplay between coagulation and platelet activation, other blood cells, role of flow (except for PFA-100/200). | Most platelet function tests are not helpful because they are not only sensitive for platelet function but also for platelet count. Flow cytometry–based analyses may have merit in a research setting. |
| Thrombin generation tests | All procoagulant and anticoagulant factors, provided thrombomodulin or another protein C activator is added to the reaction mixture. Platelet count when performed in platelet-rich plasma. | Role of blood cells and endothelial cells in supporting thrombin generation, role of flow. | Promising indicator of coagulation capacity—not yet ready for clinical use. |
| Plasma-based fibrinolysis tests | All fibrinolytic proteins except tissue-type plasminogen activator. | Role of blood cells in fibrinolysis. |
| Laboratory test . | Sensitive for . | Does not assess . | Utility in liver disease . |
|---|---|---|---|
| Whole blood viscoelastic tests | Blood cells, coagulation proteins, fibrinolytic proteins. | VWF levels, protein C system, platelet function defects, role of flow in clot formation. | Better representation of hemostatic capacity compared to routine diagnostic tests, reduces blood product use, likely underestimates hemostatic capacity. |
| Platelet function tests | Platelet function, most tests also for platelet count. | Interplay between coagulation and platelet activation, other blood cells, role of flow (except for PFA-100/200). | Most platelet function tests are not helpful because they are not only sensitive for platelet function but also for platelet count. Flow cytometry–based analyses may have merit in a research setting. |
| Thrombin generation tests | All procoagulant and anticoagulant factors, provided thrombomodulin or another protein C activator is added to the reaction mixture. Platelet count when performed in platelet-rich plasma. | Role of blood cells and endothelial cells in supporting thrombin generation, role of flow. | Promising indicator of coagulation capacity—not yet ready for clinical use. |
| Plasma-based fibrinolysis tests | All fibrinolytic proteins except tissue-type plasminogen activator. | Role of blood cells in fibrinolysis. |
PFA, platelet function analyzer; VWF, von Willebrand factor.