Coagulopathy in liver disease: Lack of an assessment tool

Table 1 Weaknesses of diagnostic tests of coagulation in liver disease

Primary haemostasis
Platelet count	Detects risks of bleeding only at extreme levels
Bleeding time	Generally, does not predict bleeding risk
Platelet function analyser	Thrombopenia makes the interpretation difficult
Thromboelastometry	Little experience in cirrhotic patients
Platelet function assay Aggregometry	Thrombopenia makes the interpretation difficult
Membrane molecule expression	Specialized laboratory; mostly, in research setting
Soluble activation markers
Platelet adhesion under flow conditions
Molecular mechanisms
Secondary haemostasis
PT and APTT	Insensitive to plasma levels of the anticoagulants
Thrombin generation	Too complex for use in routine diagnostic laboratories
Thromboelastometry	No standardization of parameters in cirrhotic patients
	Low predictive positive value
Fibrinolysis
Fibrinolysis markers	No clear evidence between hyperfibrinolysis and bleeding in cirrhotic patients
Euglobulin clot lysis time	Not widely available

PT: Prothrombin time; APTT: Activated partial thromboplastin time.