Thromboelastographic Guide for Blood Products in Cirrhotics

USE OF THROMBOELASTOGRAPHY TO GUIDE BLOOD PRODUCTS REPLACEMENT IN DECOMPENSATED CIRRHOTIC PATIENTS UNDERGOING INVASIVE PROCEDURES

Blood products are commonly used before invasive procedures in patients with end-stage liver diseases despite cirrhosis being a thrombophylic state. Traditional coagulation tests (namely INR and PLTs count) are known to be unreliable in predicting bleeding risk before invasive procedures and in representing the real coagulation status of cirrhotic patients. Notwithstanding they are still used to guide blood products administration before invasive procedures. Thromboelastography (TEG) has been shown to be effective in detecting signs of hypo-hypercoagulability possibly being an alternative method to guide blood products transfusion. The aim of this randomized controlled study was to evaluate the efficacy of TEG as a guide for blood products transfusion in cirrhotic patients undergoing invasive procedures.

Inclusion Criteria:

• Histologic or imaging-proven liver cirrhosis of any etiology
• INR>1.8 and/or PLTs count <50x103/μl

Exclusion Criteria:

• Ongoing bleeding
• Previous or current thrombotic events defined as any documented blood clot in a venous or arterial vessel
• Ongoing antiplatelet or anticoagulant therapy or stopped less than 7 days before evaluation for the study
• Presence of sepsis according to ACP-SCCP criteria
• Hemodialysis performed within 7 days