Thromboelastography guided blood product transfusion in cirrhosis patients with acute variceal bleeding: A randomized controlled trial

Rout, G. R.; Gunjan, Deepak; Kedia, Saurabh; Nayak, Baibaswat; Mahapatra, Soumya Jagannath; Iqbal, Atif; Shalimar, S.

doi:10.1016/s0168-8278(18)31677-5

Cited by 31 publications

(65 citation statements)

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“…Recently, a randomized control trial of cirrhotics with acute variceal bleeding was given blood products based on VET‐guided transfusions, 13.3% vs. standard of care guided, 100%. The rebleeding rate was similar at 5 days after the acute bleed, but significantly less at 42 days postbleed and 6‐week mortality was lower in the VET‐guided transfusion group . These findings may be from lower portal pressures from less blood product transfusions which favors having a more restrictive transfusion guideline in cirrhotic patients.…”

Section: Transfusion Guided By Viscoelastic Testingsupporting

confidence: 56%

“…Currently, VET is widely used at liver transplant centers to guide transfusion and has been shown to decrease blood transfusions intraoperatively compared to transfusions based on standard of care . There is an increasing body of evidence that suggests VET‐guided transfusions reduce the number of blood products provided in acute variceal bleeding and before minor procedures …”

Section: Resultsmentioning

confidence: 99%

“…The rebleeding rate was similar at 5 days after the acute bleed, but significantly less at 42 days postbleed and 6-week mortality was lower in the VET-guided transfusion group. 83 These findings may be from lower portal pressures from less blood product transfusions which favors having a more restrictive transfusion guideline in cirrhotic patients.…”

Section: Tranexamic Acidmentioning

confidence: 99%

“…79 There is an increasing body of evidence that suggests VET-guided transfusions reduce the number of blood products provided in acute variceal bleeding and before minor procedures. 82,83 In regards to future direction, many groups are still hoping to answer the question of which transfusion strategy is optimal in patients with cirrhosis. The POCKET trial 99 attempted to compare three transfusion strategies (routine coagulation test-guided, ordinary or restrictive, or VET-guided) prior to central venous catheterization in critically ill patients with cirrhosis; however, the trial was terminated early due to low inclusion.…”

Section: Con Clus Ionmentioning

confidence: 99%

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Transfusion strategies in patients with cirrhosis

Liu

Hum

Jou

et al. 2019

European J of Haematology

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Bleeding related to portal hypertension and coagulopathy is a common complication in patients with cirrhosis. Complications and management of bleeding is a significant source of healthcare cost and utilization, as well as morbidity and mortality. Due to the scarcity of evidence surrounding transfusion strategies and hemostatic interventions in patients with cirrhosis, there has been significant debate regarding the best practice. Emerging data suggest that evidence supporting transfusion of packed red blood cells to a hemoglobin threshold of 7‐8 g/dL is strong. thrombopoietin (TPO) receptor agonists have shown promise in increasing platelet levels and reducing transfusions preprocedurally, although have not specifically been found to reduce bleeding risk. Data for viscoelastic testing (VET)‐guided transfusions appear favorable for reducing blood transfusion requirements prior to minor procedures and during orthotopic liver transplantation. Hemostatic agents such as recombinant factor VIIa, prothrombin complex concentrates, and tranexamic acid have been examined but their role in cirrhotic patients is unclear. Other areas of growing interest include balanced ratio and whole blood transfusion. In the following manuscript, we summarize the most up to date evidence for threshold‐guided, VET‐guided, balanced‐ratio, and whole blood transfusions as well as the use of hemostatic agents in cirrhotic patients to provide practice guidance to clinicians.

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Section: Transfusion Guided By Viscoelastic Testingsupporting

confidence: 56%

Section: Resultsmentioning

confidence: 99%

Section: Tranexamic Acidmentioning

confidence: 99%

Section: Con Clus Ionmentioning

confidence: 99%

See 2 more Smart Citations

Transfusion strategies in patients with cirrhosis

Liu

Hum

Jou

et al. 2019

European J of Haematology

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“…Similar issues are prevalent in other studies using TEG and viscoelastic testing. 23,24 Further validation of viscoelastic parameters in patients with liver disease is needed and valid control interventions should be a priority.…”

Section: Shortcomings In Design and Analysis Of Clinical Studies On Bmentioning

confidence: 99%

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

Davis

2020

Semin Thromb Hemost

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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.

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