Related Experiment Video
Updated: Jul 29, 2026
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Comparison of three transfusion protocols prior to central venous catheterization in patients with cirrhosis: A
Leonardo L Rocha1,2, Ary S Neto1,3,4, Camila M S Pessoa1
1Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Insights
A restrictive transfusion strategy significantly reduces blood component use and costs in critically ill cirrhosis patients undergoing central venous catheterization. This approach did not increase bleeding events, offering a safer and more economical alternative.
Area of Science:
- Hepatology
- Critical Care Medicine
- Transfusion Medicine
Background:
- Transfusion of blood components before invasive procedures in cirrhosis patients is common.
- This practice is linked to increased adverse events.
- Optimizing transfusion strategies is crucial for patient safety and resource management.
Purpose of the Study:
- To compare the efficacy and safety of three distinct transfusion strategies.
- To evaluate transfusion rates, bleeding incidence, and adverse events.
- To determine the most effective approach for central venous catheterization in cirrhosis patients.
Main Methods:
- A single-center randomized trial was conducted.
- Critically ill cirrhosis patients requiring central venous lines were enrolled.
- Three transfusion strategies were compared: restrictive, thromboelastometry-guided, and usual care (coagulogram-guided).
Main Results:
- The restrictive strategy led to significantly lower transfusion rates (15.8%) compared to thromboelastometry-guided (68.4%) and coagulogram-guided (73.7%) protocols.
- No significant differences in bleeding incidence, length of stay, mortality, or transfusion-related adverse events were observed across the groups.
- The restrictive protocol demonstrated cost savings.
Conclusions:
- A restrictive transfusion strategy effectively reduces blood component use and associated costs in critically ill cirrhosis patients.
- This strategy is safe, with no increased risk of bleeding compared to other methods.
- Restrictive transfusion protocols represent a valuable approach for managing cirrhosis patients undergoing invasive procedures.
Background:
Transfusion of blood components prior to invasive procedures in cirrhosis patients is high and associated with adverse events.
Objectives:
We compared three transfusion strategies prior to central venous catheterization in cirrhosis patients.
Patients/Methods:
Single center randomized trial that included critically ill cirrhosis patients with indication for central venous line in a tertiary private hospital in Brazil.
Interventions:
Restrictive protocol, thromboelastometry-guided protocol, or usual care (based on coagulogram). The primary endpoint was the proportion of patients transfused with any blood component (ie, fresh frozen plasma, platelets, or cryoprecipitate). The secondary endpoints included incidence of bleeding and transfusion-related adverse events.
Results:
A total of 57 patients (19 per group; 64.9% male; mean age, 53.4 ± 11.3 years) were enrolled. Prior to catheterization, 3/19 (15.8%) in the restrictive arm, 13/19 (68.4%) in the thromboelastometry-guided arm, and 14/19 (73.7%) in the coagulogram-guided arm received blood transfusion (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-0.45; P = .002 for restrictive versus coagulogram-guided arm; OR, 0.09; 95% CI, 0.01-0.56; P = .006 for restrictive versus thromboelastometry-guided arm; and OR, 0.77; 95% CI, 0.14-4.15; P = .931 for thromboelastometry-guided versus coagulogram-guided arm). The restrictive protocol was cost saving. No difference in bleeding, length of stay, mortality, and transfusion-related adverse events was found.
Conclusions:
The use of a restrictive strategy is associated with a reduction in transfusion prior to central venous catheterization and costs in critically ill cirrhosis patients. No effect on bleeding was found among the groups.
