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. Regardless of their real coagulation status, an elevated INR, e.g. for paracentesis, is just a nuisance. It should not stop paracentesis, except in the more extreme circumstances. However, in perceived more complicated procedures, such as thoracentesis - which are to be usually done by other proceduralists, they will have their own criteria of what constitutes coagulation concerns. In such cases, a TEG/ROTEM might be pre-emptively invoked (if a...