Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1541
Peer-review started: April 29, 2015
First decision: August 26, 2015
Revised: September 29, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 28, 2016
Core tip: Hemostasis in patients presenting for liver transplantation is often characterized by a reduction in both pro- and anticoagulant factors. During surgery, the rebalanced hemostasis system can be stressed by bleeding, hemodynamic shock, tissue damage or substitution of blood products with resultant diffuse bleeding or thrombus formation. Thrombelastography/thrombelastometry can guide substitution of blood products and reduces bleeding, transfusion of blood products, and eventual mortality. It is, however, important to state that bed-side methods are not capable of detecting alterations in anticoagulant pathways. Thus cautious coagulation management is recommended to avoid potential devastating thrombotic complications.