Viscoelastic Testing Prior to Non-surgical Procedures Reduces Blood Product Use Without Increasing Bleeding Risk in Cirrhosis

Prophylactic fresh frozen plasma versus prothrombin complex concentrate for preprocedural management of the coagulopathy of liver disease: A systematic review

“…37 Multiple meta-analyses suggest a TEG or ROTEM-guided transfusion protocol decreased the use of blood products without a change in safety outcomes in patients with chronic liver disease. 37,38 A multicenter, randomized controlled trial (http://www.trial regis ter.…”

“…Furthermore, the coagulopathy of liver disease is complex, and PT/INR, although commonly used to guide the administration of hemostatic agents, has been previously shown not to correlate with bleeding events 36 . Use of other laboratory techniques (eg, ROTEM or TEG) have been studied in the coagulopathy of liver disease and may be preferred for guiding hemostatic factor management rather than traditional PT/INR 37 . Multiple meta‐analyses suggest a TEG or ROTEM‐guided transfusion protocol decreased the use of blood products without a change in safety outcomes in patients with chronic liver disease 37,38 .…”

“… 36 Use of other laboratory techniques (eg, ROTEM or TEG) have been studied in the coagulopathy of liver disease and may be preferred for guiding hemostatic factor management rather than traditional PT/INR. 37 Multiple meta‐analyses suggest a TEG or ROTEM‐guided transfusion protocol decreased the use of blood products without a change in safety outcomes in patients with chronic liver disease. 37 , 38 A multicenter, randomized controlled trial ( http://www.trialregister.nl NTR3174) to address the use of PCC versus placebo before liver transplantation began enrollment in 2012, but its status is currently unclear.…”

“… 37 Multiple meta‐analyses suggest a TEG or ROTEM‐guided transfusion protocol decreased the use of blood products without a change in safety outcomes in patients with chronic liver disease. 37 , 38 A multicenter, randomized controlled trial ( http://www.trialregister.nl NTR3174) to address the use of PCC versus placebo before liver transplantation began enrollment in 2012, but its status is currently unclear. 39 Additional questions remain on the optimal dosing of PCC as in vitro studies suggest that the coagulopathy of liver disease may require lower doses than that required for warfarin reversal.…”

Role of Viscoelastic and Conventional Coagulation Tests for Management of Blood Product Replacement in the Bleeding Patient

“…91 In comparison to standard coagulation tests, a VET-guided approach to the perioperative assessment and reversal of coagulopathy in cirrhotic patients can improve transfusion stewardship by reducing the number of patients exposed to blood transfusions or reducing the number of transfused blood products without increasing hemorrhagic complications, length of hospital stay, or mortality. 92 93 94 While VET-based transfusion algorithms appear optimally suited to reduce blood loss and transfusion requirements for liver transplant, there is currently no evidence to suggest that VET-based protocols provide a survival benefit and more research is needed to understand the significance on clinical outcome data. 95…”