How do you approach the use of viscoelastic assays (ex: TEG, ROTEM) in patients with identified coagulopathy in the peri-procedural period?  

Coagulopathy requires consideration, but not necessarily action. The usual way it is invoked is by an elevated INR result - but this does not imply auto-anti-coagulation (as coumadin on INR). PVT is very common in PHTN/cirrhosis. Thus, in many cases, it depends on the procedure and the proceduralist...