Patients with cirrhosis are known to have an abnormal coagulation status, which is a particular concern when planning invasive procedures in which blood loss is possible or predictable. Careful consideration must be given to the bleeding risk for each individual patient and coagulation management strategies should be established in advance of procedural interventions, where possible. Perioperative clinical decision-making should utilize viscoelastic testing in addition to usual assessments, where possible, and focus on the well-established three pillars of patient blood management: optimization of erythropoiesis, minimization of bleeding and blood loss, and management of anemia. Restrictive transfusion policies, careful hemostatic monitoring, and a proactive approach to predicting and preventing bleeding on an individual patient basis should be central to managing perioperative bleeding in the fragile patient population with cirrhosis. This review discusses coagulation assessments and bleeding management techniques necessary before, during, and after surgical interventions in patients with cirrhosis, and provides expert clinical opinion and physician experience on the perioperative management of these patients.

众所周知，肝硬化患者的凝血状态异常，在计划可能或可预测失血的侵入性手术时，这是一个特别值得关注的问题。必须仔细考虑每个患者的出血风险，并尽可能在手术干预之前制定凝血管理策略。围手术期临床决策除了常规评估外，还应尽可能利用粘弹性测试，并重点关注患者血液管理的三大支柱：优化红细胞生成、最大限度减少出血和失血以及贫血管理。限制性输血政策、仔细的止血监测以及针对个体患者预测和预防出血的主动方法应该是管理脆弱的肝硬化患者围手术期出血的核心。本综述讨论了肝硬化患者手术干预之前、期间和之后必要的凝血评估和出血管理技术，并提供了这些患者围手术期管理的专家临床意见和医生经验。