Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1115
Peer-review started: May 4, 2020
First decision: May 24, 2020
Revised: June 1, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: November 27, 2020
Processing time: 204 Days and 9 Hours
Conventional coagulation tests do not predict bleeding or thrombosis risk in liver cirrhosis. Viscoelastic tests of coagulation (VETs) such as thrombelastography (TEG) is a point of care test that can predict clinically significant coagulopathy and the need for blood product transfusion. Despite this, VETs have not been widely used in patients with chronic liver disease outside the transplant setting.
The systematic review provides a summary and evaluation of existing clinical evidence for VET guided transfusion in chronic liver disease. This data will be important to improve the haemostatic management in these patients.
To verify the utility of VET guided transfusion in chronic liver disease patients presenting with bleeding or who require an invasive procedure.
A comprehensive systematic literature search was performed according to the methodology of evidenced-based medicine. We included randomized controlled trials that compared the use of VET guided transfusion to conventional coagulation tests in the setting of chronic liver disease who presented with bleeding or required an invasive procedure.
Five studies were included in the analysis examining the use of TEG guided blood product transfusion in cirrhosis prior to invasive procedures, non-variceal haemorrhage, variceal haemorrhage and liver transplantation. TEG guided transfusion reduced overall blood product utilization compared to standard of care in all five studies. No increase in length of stay, mortality or risk of bleeding was observed. In those presenting with variceal bleeding, there was a statistically significant reduction in rate of re-bleeding at 42 d in the TEG arm versus standard of care.
This systematic review highlights the role of VET in reducing blood product utilization in chronic liver disease without compromising safety and may enable guidelines to be developed to ensure patients with liver disease are optimally managed.
There is an urgent need to develop protocols utilizing VET to guide transfusion in liver cirrhosis outside of the transplant setting in order to optimize haemostatic management of these patients.