Rotational Thromboelastometry Reduces the Need for Preemptive Transfusion in Cirrhosis: A Randomized Controlled Trial...

Area of Science:

• Hepatology
• Hematology
• Transfusion Medicine

Background:

• Cirrhosis impairs hemostasis, increasing bleeding risk during invasive procedures.
• Conventional coagulation tests (CCT) offer limited global hemostasis assessment in cirrhosis.
• Viscoelastic tests, such as rotational thromboelastometry (ROTEM), provide a comprehensive evaluation of blood clot formation and lysis.

Purpose of the Study:

• To compare ROTEM-guided blood product transfusion with standard of care (SOC) based on CCT.
• To determine if ROTEM guidance reduces blood product requirements in patients with cirrhosis undergoing elective invasive procedures.
• To assess the safety of ROTEM-guided transfusion in terms of procedure-related bleeding and complications.

Main Methods:

• An open-label randomized controlled trial involving 40 patients with cirrhosis and abnormal CCT.
• Patients were randomized to receive blood products guided by ROTEM or SOC.
• Primary outcome: difference in fresh frozen plasma (FFP) or platelet transfusion; Secondary outcome: procedure-related bleeding within 7 days.

Main Results:

• The ROTEM group required significantly less blood transfusion (40%) compared to the SOC group (100%) (P < 0.001).
• Reduced transfusion needs were observed for both FFP (P < 0.001) and platelets (P = 0.046).
• No significant bleeding events occurred, and transfusion-associated adverse events were rare and similar between groups.

Conclusions:

• ROTEM offers a global assessment of hemostasis in patients with cirrhosis.
• A ROTEM-based transfusion strategy significantly decreases blood product transfusion requirements in cirrhotic patients undergoing procedures.
• This approach does not increase the risk of bleeding events, making it a safe and effective transfusion strategy.