IS A THROMBOELASTOGRAPH (TEG) GUIDED BLOOD PRODUCT TRANSFUSION STRATEGY A PRACTICAL PRE-ENDOSCOPIC INTERVENTION FOR PATIENTS ADMITTED ACUTELY WITH VARICEAL HAEMORRHAGE?

Aims Management of coagulopathy in patients with cirrhosis presenting with variceal bleeding is challenging. TEG may offer a more targeted blood product transfusion approach. This study aims to evaluate the overall impact on patient care that a TEG guided blood product transfusion strategy made on patients admitted with variceal bleeding.

Methods We reviewed all acute admissions with variceal bleeding over a period of three months (August to October 2019) The TEG guided blood product transfusion strategy was compared with standard of care based on guidance from the Haematology.

Results A total of 40 cases were identified. 17 patients had a TEG performed as they were managed on the intensive care unit (Group 1). 23 patients did not have a TEG done and were given blood products as guided by the Haematology team (Group 2). In group 1, 9/17 (53%) were transfused with platelets, cryoprecipitate or FFP. 8 patients did not require transfusions as their TEG assay was normal. In group 2, 15/23 patients (65%) received blood products. On average 3 units of FFP and 2 pools of platelets were transfused in group 2 compared to 2 units of FFP and 1 pool of platelets in group 1. Overall mortality rate was 3/17 (17%) in group 1 compared to 6/23 (26%) (p value < 0.05) in group 2.

Conclusions In this observational study, Patients who had a TEG assay were less likely to have a requirement for additional blood products, and when needed received less with a more targeted correction of their clotting parameters compared to those who received standard of care. This potentially could provide cost savings as well as more prudent stewardship of much needed blood products. Further studies are required to evaluate if TEG should be used more widely, including outside of the ICU.