Abstract
Patients with cirrhosis often have abnormal hemostasis, with increased risk of hemorrhage
and thrombosis. Thromboelastography provides a rapid assessment of the coagulation
status and can guide product transfusions in adult patients with cirrhosis. This study
aimed to determine whether the use of thromboelastography in adult patients with cirrhosis
decreases blood product use and impacts adverse events or mortality compared with
standard practice. A registered (PROSPERO CRD42020192458) systematic review and meta-analysis
was conducted for randomized controlled trials (RCTs) comparing thromboelastography-guided
hemostatic management versus standard practice (control). Co-primary outcomes were
the number of transfused platelet units and fresh frozen plasma (FFP) units. Secondary
outcomes were mortality, adverse events, utilization of individual blood products,
blood loss or excessive bleeding events, hospital/intensive care unit stay, and liver
transplant/intervention outcomes. The search identified 260 articles, with five RCTs
included in the meta-analysis. Platelet use was five times lower with thromboelastography
versus the control, with a relative risk of 0.17 (95% confidence interval [CI]: [0.03–0.90];
p = 0.04), but FFP use did not differ significantly. Thromboelastography was associated
with less blood product (p < 0.001), FFP + platelets (p < 0.001), and cryoprecipitate (p < 0.001) use. No differences were reported in bleeding rates or longer term mortality
between groups, with the thromboelastography group having lower mortality at 7 days
versus the control (relative risk [95% CI] = 0.52 [0.30–0.91]; p = 0.02). Thromboelastography-guided therapy in patients with cirrhosis enhances patient
blood management by reducing use of blood products without increasing complications.
Keywords
thromboelastography - cirrhosis - blood products - patient blood management
