PB0473 - Viscoelastic Testing to Guide Transfusion Management in Patients with End Stage Liver Disease: A Systematic Review and Meta-analysis

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Muntadhar Al Moosawi, MD FRCPC

Coagulation Fellow
The University of British Columbia
Vancouver, British Columbia, Canada

Co-Author(s)

TH

Trana Hussaini

Pharmacotherapy Specialist - Liver Transplantation (Pharmacy)
University of British Columbia
Vancouver, British Columbia, Canada

Background: Standard coagulation tests (SCTs) such as INR/PT, PTT, and fibrinogen have limited utility in assessing coagulopathy in patients with end-stage liver disease (ESLD) due to “re-balanced” hemostatic activity. Observational data and small clinical trials have shown clinical utility for viscoelastic testing (VET) in this setting.

Aims: To compare transfusion requirements and clinical outcomes in patients with ESLD who are undergoing invasive procedures using VET-guided vs SCT-guided transfusions.

Methods: This was a systematic review and meta-analysis. We searched MEDLINE Ovid, Embase Ovid, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and The WHO International Clinical Trial Registry Platform databases. Only parallel randomized controlled studies were included. The primary outcome was the number of patients transfused, and the average number of blood components transfused. Post-operative bleeding, reoperation, and overall mortality were also captured.

Results: The preliminary analysis included data generated using MEDLINE Ovid search. 663 records were screened, of which 25 full texts were evaluated for eligibility, and 5 trials were included in the meta-analysis (figure 1). More patients in SCT group received blood transfusions versus the VET group (83.2% vs 46.7%; RR=0.50, p=0.12, 95% CI 0.21-1.19). VET-based transfusion led to a statistically significantly lower number of plasma units transfused (mean difference -1.34, 95% CI -1.78-0.89, p< 0.05). There was no statistically significant difference in the mean number of pRBC or platelets transfused. Although there was a trend toward lower post-operative bleeding in the VET group, this difference did not reach statistical significance (9.4% in VET and 16.8% in SCT, RR=0.51, p=0.12, 95%CI 0.33-1.13). No difference in mortality was observed (26.9% in VET and 27.7% in SCT, RR=1.02, p=0.94, 95%CI 0.54- 1.93). Figure 2 shows the forest plots for each outcome.

Conclusion(s): VET-guided transfusions in patients with ESLD resulted in a reduced proportion of patients transfused as well as lower mean plasma transfusion requirements.