A Randomized Control Trial of Thromboelastography-Guided Transfusion in Cirrhosis for High-Risk Invasive Liver-Related Procedures

Dig Dis Sci. 2020 Jul;65(7):2104-2111. doi: 10.1007/s10620-019-05939-2. Epub 2019 Nov 13.

Abstract

Background and aim: Hemostasis in cirrhosis is dynamic and balanced. Thromboelastography (TEG) assesses global coagulation status. We aimed to assess whether TEG-guided blood product transfusions result in lower blood product requirements in patients with cirrhosis undergoing invasive liver-related procedures as compared to the conventional standard of care (SOC).

Methods: In this open-label, randomized controlled trial, cirrhosis patients with coagulopathy, undergoing invasive liver-related procedures, were randomized to either TEG-guided blood product transfusion or SOC. The primary outcome was difference in the amount of fresh frozen plasma (FFP) and platelet units transfused between the two groups. The secondary outcome was procedure-related bleeding complications within 5 days and any complications until 28 days.

Results: From November 2017 till June 2019, 58 patients were recruited (29: TEG and 29: SOC). Most common procedures performed were percutaneous liver biopsy (n = 48), followed by transjugular intrahepatic portosystemic shunt (n = 2), percutaneous acetic acid injection (n = 2), and transarterial chemoembolization (n = 2). There were no differences in baseline demographics, hemostatic profile, and types of procedures between the two groups. Only nine patients in TEG group received transfusions compared to all patients in SOC (31% vs 100%; P < 0.001). In TEG group, six (20.7%) received FFP (P = 0.753 vs. SOC), two (6.9%) received platelets (P < 0.001 vs. SOC), and 1(3.4%) patient received both FFP and platelet (P ≥ 0.999 vs. SOC) transfusion. None of the patients in either group developed procedure-related bleeding complications until 5 days post-procedure. The complication rates at 28-day follow-up were similar between the groups.

Conclusion: TEG-guided blood product transfusion strategy reduces blood product transfusion without increased risk of bleeding in cirrhotic patients undergoing invasive liver-related procedures (CTRI/2017/12/010822).

Keywords: CTP; Coagulopathy; Intervention; Liver biopsy; MELD.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetic Acid
  • Adult
  • Biopsy
  • Blood Coagulation Disorders / diagnosis*
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / therapy
  • Blood Component Transfusion / statistics & numerical data*
  • Chemoembolization, Therapeutic
  • Female
  • Humans
  • Image-Guided Biopsy
  • Injections
  • International Normalized Ratio
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / complications
  • Male
  • Middle Aged
  • Patient Selection
  • Plasma
  • Platelet Transfusion / statistics & numerical data
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / prevention & control*
  • Punctures
  • Sphincterotomy, Endoscopic
  • Thrombelastography*
  • Thrombocytopenia / blood*
  • Thrombocytopenia / etiology
  • Young Adult

Substances

  • Acetic Acid

Associated data

  • CTRI/CTRI/2017/12/010822