Thromboelastography-guided assessment of coagulation in decompensated liver cirrhosis for the evaluation of blood component transfusions

Aim of the study:
The primary objective of this study was to assess the impact of thromboelastography (TEG) on the decision-making process of gastroenterologists and hepatologists regarding blood component (BC) transfusions in patients with decompensated cirrhosis before invasive manipulations.

Material and methods:
This study was a prospective, single-center, randomized controlled trial. Throughout the trial, the decision-making process was not actively influenced. However, TEG results were made available to the physicians, offering recommendations regarding the need for specific BC transfusions. To assess whether the availability of TEG data influences clinical decision-making, a subsequent statistical analysis was conducted.

Results:
After application of exclusion criteria, 20 patients were enrolled in the study. The results showed that in the TEG group, the need for BC transfusions was 20% lower than in the control group, although this difference was not statistically significant (p = 0.384). When hypothesizing that all patients in the TEG group would have received BC transfusions prior to the procedure, TEG was estimated to reduce transfusion requirements by 69.2%. However, this reduction was also not statistically significant (p > 0.05).

Conclusions:
In settings where nearly all physicians were familiar with the concept of hemostatic changes in liver cirrhosis, TEG was estimated to reduce transfusion requirements by 20%.