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TEG-guided transfusion in cirrhosis lowers use of blood products

When compared with standard of care, thromboelastography-guided transfusion required less blood products without increasing bleeding complications among patients with cirrhosis and significant coagulopathy before invasive procedures.

Researchers, including Erica Villa, MD, department of internal medicine, Gastroenterology Unit, Università degli Studi di Modena & Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Italy, randomly assigned 60 patients to 10 mL/kg of thromboelastography (TEG)-guided transfusion strategy (n = 30) or standard of care (n = 30). The TEG patients received fresh frozen plasma (FFP) if the reaction time was greater than 40 min and/or platelets if maximum amplitude was less than 30 mm. All patients who received standard of care received FFP (10 mL/kg) and/or platelets (1 unit) per hospital guidelines.

All patients in the standard of care group received blood product transfusions vs. five in the TEG group (100% vs. 16.7%; P < .0001). Among patients in the standard of care group, 16 received FFP, 10 received platelets and four received both, compared with no patients in the TEC group receiving FFP alone (P < .0001 vs. standard of care), two receiving platelets (6.7%; P = .009 vs. standard of care) and three receiving both FFP and platelets. Post procedure bleeding occurred in only one patient in the standard of care group after large-volume paracentesis.

No side effects due to transfusion were observed in the TEG group; however, 3.3% of patients in the standard of care group experienced an allergic reaction during FFP transfusion. One patient in the standard of care group experienced post-procedure bleeding after large-volume paracentesis. No patients in the TEG group showed bleeding events as a result of the procedure.

Fifteen patients died within 90 days of the procedure, mostly due to end-stage liver disease. “High-risk bleeding procedure and blood product transfusion were not associated with mortality,” according to the researchers.

“Further studies stratifying the bleeding risk according to single invasive procedures and to subgroups of patients with cirrhosis … will better clarify the impact of TEG in the prediction of hemorrhagic risk in patients with liver cirrhosis and coagulopathy,” the researchers wrote. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.