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World J Gastroenterol. Mar 7, 2023; 29(9): 1460-1474
Published online Mar 7, 2023. doi: 10.3748/wjg.v29.i9.1460
Approach to thromboelastography-based transfusion in cirrhosis: An alternative perspective on coagulation disorders
Sahil Kataria, Deven Juneja, Omender Singh
Sahil Kataria, Deven Juneja, Omender Singh, Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
Author contributions: Kataria S and Juneja D wrote the manuscript, researched the project, prepared the figures and tables, and performed data acquisition; Singh O reviewed draft and final versions of the manuscript.
Conflict-of-interest statement: No conflict-of-interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, FCCP, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1, Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: October 15, 2022
Peer-review started: October 15, 2022
First decision: January 3, 2023
Revised: January 12, 2023
Accepted: February 27, 2023
Article in press: February 27, 2023
Published online: March 7, 2023
Processing time: 143 Days and 2.2 Hours
Abstract

Viscoelastic tests, specifically thromboelastography and rotational thromboelastometry, are increasingly being used in the management of postoperative bleeding in surgical intensive care units (ICUs). However, life-threatening bleeds may complicate the clinical course of many patients admitted to medical ICUs, especially those with underlying liver dysfunction. Patients with cirrhosis have multiple coagulation abnormalities that can lead to bleeding or thrombotic complications. Compared to conventional coagulation tests, a comprehensive depiction of the coagulation process and point-of-care availability are advantages favoring these devices, which may aid physicians in making a rapid diagnosis and instituting early interventions. These tests may help predict bleeding and rationalize the use of blood products in these patients.

Keywords: Bleeding; Chronic liver disease; Cirrhosis; Thromboelastography; Viscoelastic tests

Core Tip: Viscoelastic hemostatic assays are increasingly used as “point-of-care” tests, providing real-time, dynamic insight into the complex coagulation aberrations seen in cirrhotic patients. In cirrhosis, all patients undergoing a high-risk invasive procedure or who are actively bleeding should undergo thromboelastography (TEG) on initial evaluation, if this testing is available. Any reasonable TEG-based strategy will likely represent an improvement over strategies using traditional coagulation tests. The best approach will be to use TEG supplemented by standard platelet count and fibrinogen testing. TEG is a promising diagnostic modality and may help in predicting bleeding and aid in the rationalization of the use of blood products in these patients.