Rotational thromboelastometry versus conventional tests in decompensated cirrhotic children undergoing invasive...

Area of Science:

• Pediatric Hematology
• Hepatology
• Transfusion Medicine

Background:

• Children with decompensated cirrhosis often experience coagulopathy and thrombocytopenia.
• Invasive procedures in these patients necessitate careful management of bleeding risks.
• Rotational thromboelastometry (ROTEM) offers real-time assessment of hemostasis.

Purpose of the Study:

• To evaluate the efficacy and safety of a ROTEM-guided transfusion strategy.
• To compare ROTEM-guided transfusion with standard criteria in pediatric patients undergoing invasive procedures.
• To assess the impact on transfusion requirements, complications, and costs.

Main Methods:

• An open-label, randomized controlled trial (RCT) involving children aged 6 months to 18 years with decompensated liver cirrhosis.
• Patients with specific international normalized ratio (INR) or platelet count thresholds were randomized.
• Blood component transfusions were administered based on predefined criteria in both ROTEM-guided and standard care arms.

Main Results:

• A ROTEM-guided strategy significantly reduced the proportion of patients receiving any blood component transfusion (76.3% vs. 100%).
• However, the total volume of blood components transfused and the incidence of procedure-related bleeding or transfusion complications were comparable between groups.
• The ROTEM-guided approach resulted in higher total costs compared to standard care (p < 0.001).

Conclusions:

• ROTEM-guided transfusion in children with decompensated cirrhosis and coagulopathy decreases overall transfusion exposure.
• This strategy did not lead to a reduction in blood product volume transfused.
• The ROTEM-guided approach was not found to be cost-effective within the study's parameters.