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Updated: Jul 9, 2026
07:10
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Viscoelastic Tests in Cirrhotic Patients Undergoing Invasive Procedures: A Systematic Review and Meta-Analysis of
Andrea Boccatonda1, Elena Campello2, Angela Napolitano2
1Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Summary
Viscoelastic testing (VET) guided transfusion strategies reduce blood product use in cirrhotic patients undergoing procedures without increasing bleeding risk. This physiology-based approach optimizes patient safety and resource utilization.
Area of Science:
- Hepatology and Coagulation Science
- Transfusion Medicine
- Medical Device Technology
Background:
- Conventional coagulation tests inadequately assess bleeding risk in cirrhotic patients undergoing invasive procedures.
- Current methods often lead to unnecessary blood product transfusions.
- Viscoelastic testing (VET) offers a global assessment of haemostasis, potentially improving transfusion strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of VET-guided transfusion strategies.
- To compare VET-guided versus standard-of-care transfusion in cirrhotic patients undergoing invasive procedures.
- To analyze procedure-related bleeding and transfusion requirements.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched PubMed, Embase, and Scopus databases.
- Pooled risk ratios (RRs) with 95% confidence intervals (CIs) using the Mantel-Haenszel method.
Main Results:
- Six RCTs with 296 patients were analyzed.
- No significant difference in procedure-related bleeding between VET-guided and standard care groups (RR 0.74, 95% CI 0.24-2.31).
- VET-guided strategies significantly reduced transfusion requirements for any blood product (RR 0.33), platelets (RR 0.20), and fresh frozen plasma (FFP) (RR 0.40 for any exposure, RR 0.22 for FFP-only).
Conclusions:
- VET-guided transfusion strategies effectively reduce blood product utilization in cirrhotic patients.
- These strategies do not increase bleeding risk during invasive procedures.
- Findings support a shift to physiology-based haemostasis management for improved patient outcomes and resource optimization.
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