Perioperative hemostatic management in the cirrhotic patient: a position paper on behalf of the Liver Intensive Care Group of Europe (LICAGE)

Minerva Anestesiol. 2019 Jul;85(7):782-798. doi: 10.23736/S0375-9393.19.13468-2. Epub 2019 Apr 2.


Recent data demonstrated that amongst patients undergoing elective surgery the prevalence of cirrhosis is 0.8% equating to approximately 25 million cirrhotic patients undergoing surgery each year worldwide. Overall, the presence of cirrhosis is independently associated with 47% increased risk of postoperative complications and over two and a half-increased risk of in-hospital mortality in patients undergoing elective surgery. In particular, perioperative patients with chronic liver disease have long been assumed to have a major bleeding risk on the basis of abnormal results for standard tests of hemostasis. However, recent evidence outlined significant changes to traditional knowledge and beliefs and, nowadays, with more sophisticated laboratory tests, it has been shown that patients with chronic liver disease may be in hemostatic balance as a result of concomitant changes in both pro- and antihemostatic pathways. The aim of this paper endorsed by the Liver Intensive Care Group of Europe was to provide an up-to-date overview of coagulation management in perioperative patients with chronic liver disease focusing on patient blood management, monitoring of hemostasis, and current role of hemostatic agents.

Publication types

  • Practice Guideline

MeSH terms

  • Anemia / epidemiology
  • Anemia / therapy
  • Blood Coagulation Disorders / drug therapy
  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Disorders / therapy
  • Blood Coagulation Factors / therapeutic use
  • Blood Coagulation Tests
  • Blood Loss, Surgical / prevention & control*
  • Deamino Arginine Vasopressin / therapeutic use
  • Elective Surgical Procedures*
  • Europe / epidemiology
  • Factor VIIa / therapeutic use
  • Fibrinogen / therapeutic use
  • Fibrinolysis
  • Fibrinolytic Agents / therapeutic use
  • Hemostasis / drug effects
  • Hemostasis / physiology
  • Hemostatic Techniques*
  • Hemostatics / therapeutic use
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / epidemiology
  • Perioperative Care / methods*
  • Perioperative Care / standards
  • Plasma
  • Platelet Function Tests
  • Platelet Transfusion
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / therapy*
  • Recombinant Proteins / therapeutic use


  • Blood Coagulation Factors
  • Fibrinolytic Agents
  • Hemostatics
  • Recombinant Proteins
  • prothrombin complex concentrates
  • Fibrinogen
  • recombinant FVIIa
  • Factor VIIa
  • Deamino Arginine Vasopressin