Nina Srour
PGY2 Pharmacy Resident
Houston Methodist Hospital
Houston, Texas
Disclosure information not submitted.
Jesse Harris, PharmD
Clinical Pharmacist Specialist
Houston Methodist Hospital, United States
Disclosure information not submitted.
Luma Succar, PharmD, BCCCP
Clinical Pharmacy Specialist
Houston Methodist Hospital, United States
Disclosure information not submitted.
Eric Salazar, MD, PhD
Doctor
Houston Methodist Hospital, United States
Disclosure information not submitted.
Scott Lindberg, MD
Doctor
Houston Methodist Hospital, United States
Disclosure information not submitted.
Constance Mobley, MD, PhD, PhD
Doctor
Houston Methodist Hospital, United States
Disclosure information not submitted.
Title: Evaluation of Viscoelastic Test-Guided Blood and Factor Transfusions in Cirrhotic Patients
Introduction: Patients with cirrhosis are at risk for coagulation abnormalities which conventional coagulation tests (CCT) do not accurately reflect. Thromboelastography (TEG) offers a more comprehensive assessment of coagulation and may facilitate targeted replacement of blood products. As such, we aimed to assess our institutional TEG-guided transfusion practices to understand variables impacting TEG evaluation and correction thresholds.
Methods: This was a single-center, retrospective study of critically ill, adult cirrhotic patients between May 2016-August 2020. TEGs obtained during the intra- and post-operative periods were excluded. Endpoints evaluated included a description of blood products administered, compliance with the TEG algorithm, and bleeding events. Outcomes were presented per TEG encounter using descriptive statistics.
Results: A total of 116 patients with 559 TEG results met inclusion criteria. Majority of tests were ordered for correction of coagulopathy in non-bleeding encounters (46.5%). Platelets (PLT) were the most commonly transfused products (41.3%), followed by fresh frozen plasma (FFP) (34.9%) and cryoprecipitate (31.1%). Median (interquartile range (IQR)) transfusions per TEG encounter were 1 unit (1–2) for PLT and FFP, and 10 units (10–20) for cryoprecipitate. Rate of compliance with the transfusion algorithm was 31.7%. Non-compliance was mostly driven by maximum amplitude (MA). In a subgroup-analysis of non-bleeding TEGs, under-correction for abnormal K time, α-angle, and MA was associated with a significant reduction in packed red blood cell (PRBC) transfusions. Over-correction with FFP and cryoprecipitate was higher when INR was ≥ 2 and fibrinogen < 100 mg/dL, respectively (p< 0.01). New thrombotic events occurred in 6 patients and 2 patients had transfusion-related reactions.
Conclusions: Despite the availability of TEG results, CCTs continue to influence correction of coagulopathy without reducing bleeding rates. Our review showed that transfusions based on standard TEG cutoffs was not associated with a reduction in PRBC transfusions compared to under-corrections. However, TEG thresholds that can accurately reflect underlying coagulopathy and bleeding risks of cirrhotic patients are yet to be determined.