PulmCrit (EMCrit)
PulmCrit - June 17, 2019 - By Josh Farkas
"Traditional coagulation studies (especially the INR) fail miserably in cirrhosis. Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients. This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you're not familiar with this concept already, it's explained in that post)...
Summary The Bullet:
- Problems with standard coagulation tests in cirrhosis (especially INR) are well known.
- Four RCTs show benefit of blood product administration guided by thromboelastography (TEG), compared to traditional coagulation tests. These are all single-center studies, but they seem to give a coherent message: use of traditional coagulation tests leads to over-transfusion.
- The optimal TEG-based transfusion algorithm is unclear. The studies above showed benefit from two very different TEG-based strategies. It's likely that any reasonable TEG-based strategy will represent an improvement over strategies using traditional coagulation tests.
- An approach to TEG-based transfusion in cirrhosis is provided, which is based upon these RCTs:
