PO102 | EFFICACY AND SAFETY OF VISCOELASTIC TESTING–GUIDED TRANSFUSION IN CIRRHOSIS UNDERGOING INVASIVE PROCEDURES: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Abstract
Background and Aims. Bleeding risk in cirrhotic patients undergoing invasive procedures is commonly assessed using conventional coagulation tests, such as the international normalized ratio (INR) and platelet count, often leading to prophylactic transfusion of blood products. However, these tests poorly reflect the rebalanced hemostatic state of cirrhosis. Viscoelastic testing (VET), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provides a global assessment of coagulation and may enable a more rational transfusion strategy. We aimed to evaluate the efficacy and safety of VET-guided transfusion strategies in cirrhotic patients undergoing invasive procedures. Methods. We performed a systematic review and meta-analysis of randomized controlled trials comparing VET-guided transfusion strategies with standard of care. Primary outcomes were procedure-related bleeding and transfusion requirements. Secondary outcomes included platelet transfusion, any fresh frozen plasma (FFP) exposure, and FFP-only transfusion. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using the Mantel–Haenszel method. Subgroup and sensitivity analyses were performed according to VET modality and study population. Results. Six randomized controlled trials including 296 patients were included in the quantitative synthesis. Procedure-related bleeding was rare and did not differ between groups (RR 0.74, 95% CI 0.24–2.31; I²=0%). VET-guided strategies significantly reduced transfusion requirements, including any blood product transfusion (RR 0.33, 95% CI 0.26–0.44; I²=56%), platelet transfusion (RR 0.20, 95% CI 0.13–0.32; I²=40%), and any FFP exposure (RR 0.40, 95% CI 0.28–0.57; I²=63%). A marked reduction was observed for FFP-only transfusion (RR 0.22, 95% CI 0.10–0.46; I²=81%). Results were consistent across subgroup and sensitivity analyses. Conclusions. VET-guided transfusion strategies significantly reduce blood product utilization without increasing bleeding risk in cirrhotic patients undergoing invasive procedures. These findings challenge the reliance on conventional coagulation tests and support a shift toward a physiology-based, individualized approach to hemostasis, with potential benefits for patient safety and resource optimization
Related
- RESULT-Hip. The impact of restrictive compared with liberal transfusion strategy on cardiac injury and death in patients undergoing surgery for hip fracture : protocol for a multicentre, randomized controlled trial of two blood transfusion strategies.
- Optimizing physician-patient communication through an integrated perspective of prospect theory and the ultimatum game: a controlled study among patients undergoing elective surgery or invasive procedures in a Chinese tertiary hospital
- Statistical analysis plan for transfusion of modified whole blood versus blood components therapy in patients with severe trauma: randomized controlled trial - WEBSTER trial.
- Comparison of analgesic efficacy and safety between liposomal bupivacaine and ropivacaine for paravertebral block in patients undergoing thoracoscopic lung tumor surgery: a prospective double-blind randomized controlled trial
- A randomized controlled trial of a multidisciplinary collaborative fatigue management program for patients undergoing hematopoietic stem cell transplantation: study protocol
BibTeX
@article{boccatonda2026po102,
title = {{PO102 | EFFICACY AND SAFETY OF VISCOELASTIC TESTING–GUIDED TRANSFUSION IN CIRRHOSIS UNDERGOING INVASIVE PROCEDURES: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS}},
author = {Andrea Boccatonda},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/918},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - PO102 | EFFICACY AND SAFETY OF VISCOELASTIC TESTING–GUIDED TRANSFUSION IN CIRRHOSIS UNDERGOING INVASIVE PROCEDURES: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
AU - Andrea Boccatonda
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/918
AB - Background and Aims. Bleeding risk in cirrhotic patients undergoing invasive procedures is commonly assessed using conventional coagulation tests, such as the international normalized ratio (INR) and platelet count, often leading to prophylactic transfusion of blood products. However, these tests poorly reflect the rebalanced hemostatic state of cirrhosis. Viscoelastic testing (VET), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provides a global assessment of coagulation and may enable a more rational transfusion strategy. We aimed to evaluate the efficacy and safety of VET-guided transfusion strategies in cirrhotic patients undergoing invasive procedures. Methods. We performed a systematic review and meta-analysis of randomized controlled trials comparing VET-guided transfusion strategies with standard of care. Primary outcomes were procedure-related bleeding and transfusion requirements. Secondary outcomes included platelet transfusion, any fresh frozen plasma (FFP) exposure, and FFP-only transfusion. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using the Mantel–Haenszel method. Subgroup and sensitivity analyses were performed according to VET modality and study population. Results. Six randomized controlled trials including 296 patients were included in the quantitative synthesis. Procedure-related bleeding was rare and did not differ between groups (RR 0.74, 95% CI 0.24–2.31; I²=0%). VET-guided strategies significantly reduced transfusion requirements, including any blood product transfusion (RR 0.33, 95% CI 0.26–0.44; I²=56%), platelet transfusion (RR 0.20, 95% CI 0.13–0.32; I²=40%), and any FFP exposure (RR 0.40, 95% CI 0.28–0.57; I²=63%). A marked reduction was observed for FFP-only transfusion (RR 0.22, 95% CI 0.10–0.46; I²=81%). Results were consistent across subgroup and sensitivity analyses. Conclusions. VET-guided transfusion strategies significantly reduce blood product utilization without increasing bleeding risk in cirrhotic patients undergoing invasive procedures. These findings challenge the reliance on conventional coagulation tests and support a shift toward a physiology-based, individualized approach to hemostasis, with potential benefits for patient safety and resource optimization
SN - 2785-5309
ER -