Reappraisal of the conventional hemostasis tests as predictors of perioperative bleeding in the era of rebalanced hemostasis in cirrhosis.

The new paradigm was instrumental to change the management of cirrhosis.

新的范式对于改变肝硬化的管理起到了关键作用。

For example, international guidelines warn against the entrenched practice of testing patients with conventional hemostasis tests and infusing those with abnormalities with fresh-frozen plasma, coagulation factor concentrates, or platelets, prior to surgery/invasive procedures.

例如，国际指南警告不要固守使用常规止血测试检查患者，并在手术/侵入性操作前，对那些有异常的患者输注新鲜冰冻血浆、凝血因子浓缩物或血小板。

These recommendations are, however, largely disattended.

然而，这些推荐意见在很大程度上被忽视。

The practice of testing patients with the prothrombin time or viscoelastometry and using arbitrary cutoffs to make decisions on perioperative prophylaxis is still common and probably driven by medicolegal issues.

在围手术期预防中，对患者进行凝血酶原时间或粘弹性测量测试，并使用任意临界值来做出决策的做法仍然普遍，这很可能是由医疗法律问题所驱动。

There is no doubt that prothrombin time and congeners tests are unable to predict bleeding in cirrhosis.

毫无疑问，凝血酶原时间及其类似物的检测无法预测肝硬化患者的出血风险。

However, it cannot be excluded that some tests may be useful in patients who are severely decompensated.

然而，不能排除某些检测在严重失代偿患者中可能有用。

Large prospective collaborative studies are warranted.

需要进行大规模的前瞻性协作研究。

Enrolled patients should be randomized to receive perioperative prophylaxis based on laboratory testing (eg, viscoelastometry, thrombomodulin-modified thrombin generation) or to usual care.

入组患者应随机接受基于实验室检测（例如，粘弹性测量，凝血酶生成的凝血调节蛋白修饰）的围手术期预防治疗，或接受常规护理。

However, for these trials to be useful, a third group of patients who do not receive prophylaxis should be included.

然而，为了使这些试验有用，应包括一组不接受预防治疗的患者。

In conclusion, until results from these studies are available, physicians attending cirrhosis should refrain from using laboratory tests with arbitrary cutoffs to make decision on perioperative prophylaxis.

总之，在这些研究结果公布之前，照顾肝硬化患者的医生应避免使用具有任意临界值的实验室检测来决定围手术期预防措施。

Decision should be made by considering the clinical history of individual patients and the risk of hemorrhage of specific procedures.

应通过考虑个别患者的临床病史以及特定程序的出血风险来做出决策。