The aim of this study was to assess the use of thromboelastography (TEG)-directed blood product transfusion in cirrhotic patients with acute variceal bleeding compared with conventional transfusion for correction of coagulopathy
is common in patients with cirrhosis. Recommendations for correction of conventional parameters of coagulation—platelets and the international normalized ratio before endoscopy in patients with acute variceal bleeding—need more validation.
In this randomized controlled trial, cirrhotic patients with severe coagulopathy
and acute variceal bleeding were randomized to either TEG-guided blood product transfusion or conventional transfusion from March 2017 to December 2017. The primary outcome was the difference in the amount of fresh frozen plasma and platelet units transfused between the groups. Secondary outcomes were rebleeding
at 5 days and 42 days, and 6-week mortality
Of the 60 recruited patients, 30 each were randomized to the TEG and conventional transfusion groups. There were no differences in baseline characteristic and endoscopic findings between the 2 groups. Four subjects in the TEG group received blood product transfusions versus all in the conventional transfusion group (13.3% vs. 100%; P
<0.001). The control of bleeding on initial endoscopy was similar in the 2 groups. Rebleeding
in the TEG and conventional transfusion groups at 5 days was similar [1 (3.3%) vs. 4 (13.3%), P
=0.167], whereas it was significantly less in the TEG group at 42 days [3 (10%) vs. 11 (36.7%), P
at 6 weeks was seen in 4 (13.3%) in the TEG group and in 8 (26.7%) patients in the conventional transfusion group (P
TEG-guided strategy was associated with reduced blood product transfusion to correct coagulopathy
without compromising hemostasis in cirrhotic patients (Clinical trial ID: CTRI/2017/02/007864).