Current Hematological Concepts and Viscoelastic-Based Transfusion Practices During Liver Transplantation

Purpose When the cascade model of coagulation was postulated in 1964, it convincingly explained the conventional tests of coagulation and their therapeutic applications for existing anticoagulants. But the conventional tests only tend to measure the procoagulant factors and not the anticoagulant factors present in the blood, as a result, the coagulation concept was updated to cell-based model in 2001. Despite these facts, the conventional tests are still used perioperatively in liver transplantation for blood product management, at the risk of causing over-transfusion and deleterious prothrombotic effects. This article reviews the current understanding of coagulation and suggests an improved method to manage intraoperative blood product replacement.