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

Vuyyuru, Sudheer K.; Singh, Achintya D.; Gamanagatti, Shivanand; Rout, G. R.; Gunjan, Deepak; Shalimar, S.

doi:10.1007/s10620-019-05939-2

Cited by 68 publications

(113 citation statements)

References 31 publications

Supporting

Mentioning

111

Contrasting

Order By: Relevance

“…2,16 The recent studies utilizing viscoelastic hemostatic assays support this proposal with no increased bleeding risk seen in those with abnormal hemostatic markers even in the absence of blood product support. 17,18 Incidence of Bleeding in Acute Liver Failure ALF is often associated with grossly abnormal coagulation. The prolongation of the prothrombin time is both a characteristic feature and prognostic marker.…”

Section: Discussionmentioning

confidence: 99%

“…There are two small randomized controlled trials evaluating the role of thromboelastography (TEG) in guiding use of blood products prior to procedural intervention; both illustrate the low empiric risk of bleeding in CLD. 17,18 De Pietri et al reported bleeding in only 1 of 60 patients randomized to standard of care versus TEG-guided transfusion preprocedure. 17 Of note, more than half of procedures performed were considered high bleeding risk (> 3%) with no bleeds reported following these procedures despite only five patients in the TEG arm receiving blood product support.…”

Section: Procedural Bleedingmentioning

confidence: 99%

“…Vuyyuru et al performed a similar study in 58 CLD patients undergoing high bleeding risk procedures, with again no procedural bleeding complications at 28 days (with only 9 patients in the TEG receiving transfusion support preprocedure). 18 The optimal TEG thresholds for which transfusion support should be considered remain unknown. Paracentesis and thoracocentesis are low bleeding risk procedures, frequently required in hospitalized patients with CLD.…”

Section: Procedural Bleedingmentioning

confidence: 99%

See 2 more Smart Citations

Incidence of Bleeding and Thrombosis in Patients with Liver Disease

Roberts

Bernal

2020

Semin Thromb Hemost

View full text Add to dashboard Cite

Historically, liver disease has been associated with a bleeding tendency. Global hemostatic assays have demonstrated that hemostasis is overall rebalanced, in both acute liver failure and chronic liver disease. It is now recognized that many bleeding events in chronic liver disease are mediated by portal hypertension rather than an underlying hemostatic defect. This is acknowledged in recent guidelines, which recommend against coagulation testing prior to low risk procedures in this patient group, with avoidance also of attempts at correction of prolonged coagulation times. Over time, the incidence of bleeding events has decreased in both chronic liver disease and acute liver failure, with improved supportive care, targeted treatments for underlying cause of liver disease, and the advent of liver transplantation. Concurrently, there has been increased recognition of the risk of thrombosis in chronic liver disease, with a predilection for the splanchnic vasculature. This review describes the incidence of bleeding and thrombosis in chronic liver disease and acute liver failure, including the periprocedural and liver transplantation setting.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Procedural Bleedingmentioning

confidence: 99%

Section: Procedural Bleedingmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of Bleeding and Thrombosis in Patients with Liver Disease

Roberts

Bernal

2020

Semin Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…Subsequent studies of procedural bleeding prophylaxis have suffered from similar design issues. [19][20][21] Because of the rarity in clinically meaningful bleeding and thrombosis events in patients with cirrhosis, many studies attempt to use a surrogate marker that may indicate a propensity for bleeding or clotting as an endpoint instead. Theoretically, this would allow a broader enrollment and could offer information on an intervention without a subject experiencing the adverse clinical outcome.…”

Section: Seminars In Thrombosis and Hemostasismentioning

confidence: 99%

Shortcomings in Design and Analysis of Clinical Studies on Bleeding and Thrombosis in Patients with Cirrhosis

Davis

2020

Semin Thromb Hemost

View full text Add to dashboard Cite

Significant gains have been made in our understanding of bleeding and thrombosis in patients with liver disease in recent years, with concurrent exponential growth in the scientific literature published in this realm. Clinical studies of this population are challenging for multiple reasons including some hurdles unique to this population. Cirrhosis patients as a whole, especially those with decompensated cirrhosis, are a high-risk and heterogeneous population prone to serious adverse events. Outcomes of bleeding and thrombosis are relatively rare and lack standardized, validated definitions. Standard practices for clinical care have evolved rapidly and rendered some control data uninformative. We aim to highlight these challenges and make recommendations for best practices for future study design and implementation. Multidisciplinary collaboration with proceduralists, careful study design including attention to validated clinically relevant outcomes, and aggressive pursuit of all funding streams will be key to continued scientific success in this burgeoning field.

show abstract

“…4 Accordingly application of alternative measures using more global assays of coagulation with viscoelastic testing (VET) of whole blood, such as thromboelastography (TEG) or rotational thromboelastometry (ROTEM), shows promise in hemostasis management. [5][6][7] A thorough understanding of coagulation physiology is vital for any clinician caring for patients with cirrhosis. As cirrhosis progresses patients are frequently hospitalized and will undergo procedures.…”

mentioning

confidence: 99%