Blood conservation strategies in liver transplantation: Past, present, and future

Table 4 Traditional and newer methods of coagulation assessment in liver disease and liver transplantation

Assessment method	What It measures?	Key findings	Clinical utility	Major limitations	Ref.
Prothrombin time (PT)	Extrinsic and common pathway clotting factors	Prolonged due to reduced procoagulant factor synthesis	Historically used to assess bleeding risk	Does not account for reduced anticoagulants; poor bleeding predictor	[88,89]
International normalized ratio (INR)	Standardized PT (warfarin-based)	Elevated despite thrombotic risk	Not validated for bleeding risk	Misleading INR	[90-92]
Platelet count	Platelet quantity	Thrombocytopenia common but bleeding unpredictable	Baseline assessment	Does not reflect platelet function	[93]
aPTT	Intrinsic pathway (kaolin-based)	Often prolonged; kaolin-based activation	Screening test	Poor correlation with actual coagulation status	[94]
Fibrinogen (Clauss)	Functional fibrinogen level	May be low, normal, or high depending on disease stage	Guides cryoprecipitate use	Does not detect dysfibrinogenemia	[95]
D-dimer	Fibrin degradation	Often elevated regardless of bleeding	Marker of fibrinolysis	Poor specificity in cirrhosis	[89]
Static plasma-based testing	Traditional labs (combined)	Fail to predict bleeding vs thrombosis	Preoperative screening	Cannot reflect “rebalanced hemostasis”	[96]

aPTT: Activated partial thromboplastin time; D-dimer: Fibrin degradation product D-dimer; Clauss: Clauss method for fibrinogen measurement.