Systematic Reviews
Copyright ©The Author(s) 2020.
World J Hepatol. Nov 27, 2020; 12(11): 1115-1127
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1115
Table 3 Randomised control trials assessing the use of thromboelastography in liver disease
Ref.YearNo. of patientsMethod of TEGTEG thresholds for transfusionSOC thresholds for transfusionOutcomes: Blood product usageOutcomes: Other
Wang et al[20]201028TEG 5000FFP titrated to maintain R time < 10 minFFP titrated to maintain PT and APTT at less than one and a half times controlStatistically significant reduction in FFP use in TEG group (12.8 units in TEG group vs 21.5 units in control group, P < 0.05)Trend towards reduction in blood loss in the TEG arm (not statistically significant)
14 TEGKaolin activated
14 SOC
SDAP when MA < 55 mm*
5 pooled units of cryoprecipitate when alpha angle < 45 degrees**Platelets to maintain a platelet count ≥ 50 × 109No reduction in RBC, Platelet or cryoprecipitate useNo statistically significant difference in mortality at 3 yr
Cryoprecipitate to maintain fibrinogen > 1 g/L
De Pietri et al[21]201660TEG 5000FFP, 10 mL/kg*** when R time > 40 min1FFP, 10 mL/kg*** when INR > 1.8Statistically significant reduction in FFP use in TEG group. (Total amount of FFP transfused in those undergoing a low risk procedure: 4000 mL in TEG group vs 11050 mL in SOC group, P = 0.002) (Total amount of FFP transfused in those undergoing a high-risk procedure: 0 mL in TEG group vs 6500 mL in SOC group)No statistically significant difference in periprocedural bleeding complications.
30 TEGNative blood (no activators)
30 SOC
SDAP when MA < 30 mm*SDAP when platelets < 50 × 109*Statistically significant reduction in platelets transfused. (6.7% required a platelet transfusion in the TEG arm vs 33.3% in the SOC arm, P = 0.021)Periprocedural bleeding events were rare with only one patient experiencing post procedure bleeding.
Rout et al[22]201960MonoTEM-A®FFP, 5 mL/kg*** when R time > 15 minFFP, 5 mL/kg*** when INR > 1.8Statistically significant reduction in FFP use. (13.3% receiving FFP in the TEG group vs 46.7% in the SOC group P = 0.010. 1345 ml LFFP transfused in the TEG group vs 4605 mL in the SOC)No difference in initial control of bleeding
30 TEG
Native (no activators)
30 SOC
No difference in rates of re-bleeding at 5 d
3 pooled units of platelets when MA < 30 mm*3 pooled units of platelets when platelet count < 50 × 109*
Statistically significant reduction in rebleeding at 42 d (10% in the TEG group vs 36.7% in SOC, P = 0.012)
Statistically significant reduction in platelets transfused (10% in TEG group vs 70% SOC group P < 0.001. Total vol. of platelets transfused: 450 mL platelets in the TEG group vs 3450 mL in the SOC)
No difference in mortality at 6 wk (13.3% in TEG group vs 26.7% in SOC, P = 0.176)
No difference in RBC transfusion
Kumar et al[23]201996TEG 5000FFP, 10 mL/kg*** when R time > 10 minFFP, 10 mL/kg*** if INR > 1.8Statistically significant reduction in FFP use (Total FFP transfused 440 mL in TEG vs 880 mL in SOC, P < 0.01)Statistically significant reduction in transfusion related adverse events (30.6% in TEG group vs 74.5% in SOC P < 0.01)2
49 TEGKaolin activated
47 SOC
SDAP when MA < 55 mm*SDAP when platelets < 50 × 109*Statistically significant reduction in platelets transfused (Average of 1 SDAP unit per patient in TEG group vs 2 SDAP units in SOC, P < 0.01)
5 pooled units of cryoprecipitate when alpha angle < 45 degrees**5 pooled units of cryoprecipitate if fibrinogen < 80 mg/dL**
Statistically significant reduction in ICU length of stay (median of 2 d in TEG arm vs 3 d in SOC. P = 0.012)
Statistically significant reduction in amount of cryoprecipitate used. (4 units in TEG group vs 16 in SOC group. P < 0.01)No difference in failure to control bleeding at day 5 or rebleeding at day 42.
No difference in 5-d and 42-d mortality
Vuyyuru et al[19]201958MonoTEM-A®FFP 5 mL/kg when R time > 14 min***FFP 5 mL/kg*** if INR ≥ 1.8No statistically significant difference in the amount of FFP transfused (24.1% requiring FFP in the TEG group vs 27.6% in the SOC, P = 0.764)No difference in post procedure bleeding complications (0% in both groups)
29 TEGNative (no activators)
29SOC
3 pooled units of platelets when platelet count < 50 × 109*
3 pooled units of platelets when MA < 32 mm*
No difference in pre and post procedure haemoglobin levels (TEG group: 11.3 ± 2.1 g/dL vs 11.2 ± 2.0 g/dL, P = 0.979; SOC group: 10.4 ± 2.1 g/dL vs 10.2 ± 2.0 g/dL, P = 0.205)
Statistically significant reduction in platelets transfused (10.3% requiring platelet transfusion in the TEG group vs 75.9% in the SOC group, P < 0.001)