Thromboelastography for Assessing the Risk of Bleeding in Patients With Cirrhosis-Moving Closer

Area of Science:

• Hepatology
• Transfusion Medicine
• Clinical Pathology

Background:

• Conventional coagulation tests (CCTs) inadequately assess bleeding risk in cirrhosis patients.
• Current practices of correcting CCTs before invasive procedures lack evidence and can be harmful.

Purpose of the Study:

• To evaluate the predictive value of CCTs and thromboelastography (TEG) for post-procedural bleeding in cirrhosis patients.
• To determine if TEG can improve bleeding risk assessment compared to CCTs.

Main Methods:

• Prospective study of 150 cirrhosis patients undergoing invasive procedures.
• Assessed bleeding time (BT), clotting time (CT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count, thromboplastin generation time (TGT), and TEG.
• Monitored for post-procedural bleeding without prophylactic transfusions.

Main Results:

• BT, CT, and TGT were normal in all patients; only one patient had significant bleeding.
• INR, aPTT, and platelet count did not significantly correlate with bleeding risk.
• TEG showed normal R time and MA values in 61% and 75% of patients, respectively, even with abnormal CCTs. Abnormal TEG values were less frequent than abnormal INR or platelet counts in non-bleeding patients.

Conclusions:

• Abnormal CCTs in cirrhosis patients do not reliably predict bleeding risk.
• TEG may offer a more accurate assessment of bleeding risk for invasive procedures in cirrhosis, aiding in the prevention of unnecessary prophylactic transfusions.