REBEL Crit, REBEL EM - By Cheng Ng - September 26, 2022
Article: Kumar M et al. Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial. Hepatology. 2020;71(1):235-246. PMID: 31148204
Clinical Question: Does a TEG-guided transfusion strategy lead to lower use of blood products compared with standard practice (guided by PT and INR) in acute non-variceal bleeding among patients with advanced cirrhosis?
Author’s Conclusion: “Among patients with advanced cirrhosis with coagulopathy and nonvariceal upper GI bleeding, TEG guided transfusion strategy leads to a significant lower use of blood components compared with SOC (transfusion guided by INR and PLT count), without an increase in failure to control bleed, failure to prevent rebleed, and mortality.”
Our Conclusion: Overall, we agree with the authors’ findings. Patients with advanced cirrhosis and nonvariceal upper GI bleeding transfused using a TEG-guided strategy required less FFP, platelets, and cryoprecipitate. In addition, they experienced fewer transfusion-related reactions, with no difference in mortality rates compared to the SOC group. We would advocate for using a TEG-guided transfusion strategy in this patient population as it would conserve precious resources while obtaining similar health outcomes. However, EGD results confirming nonvariceal bleeding would likely be unavailable outside the ICU.