Rotational Thromboelastometry Reduces Fresh Frozen Plasma Requirement in Patients without Liver Disease Undergoing Therapeutic Endoscopic Procedures with Deranged Screening Coagulation Tests—A Pilot Study

IF 0.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Endoscopy Pub Date : 2023-11-15 DOI:10.1055/s-0043-1776714

P. K. Bharadwaj, E. Simon, R. Dave, T. Geevar, Sukesh Nair, A. Abraham, A. J. Joseph, A. Dutta, S. Chowdhury, Rajeeb Jaleel, Anoop John, Ajith Thomas, DM George Simon

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引用次数: 0

Abstract

Abstract Background/Aims Rotational thromboelastometry (ROTEM) is a viscoelastic test that is used in patients with liver disease for guiding blood component use. This study is aimed at comparing the amount of blood products transfused and bleeding rates in patients without liver disease, who underwent therapeutic endoscopic procedures with deranged screening coagulation tests (prothrombin time [PT]; activated partial thromboplastin time [aPTT]), with and without hypocoagulable ROTEM. Methods Patients with deranged PT and aPTT without liver disease who underwent therapeutic endoscopic interventions during the period 2020 to 2022 were retrospectively analyzed. Baseline parameters, amount of blood products transfused, and outcomes such as 30-day bleeding and mortality rates were recorded in those with and without hypocoagulable ROTEM. Results Of the 204 patients with deranged PT/aPTT who underwent therapeutic endoscopy during the study period, 180 of those with liver disease were excluded. Six patients (M:F = 5:1; median age: 37, 20–54 years) had hypocoagulable ROTEM and 18 patients (M:F = 11:7; median age: 56, 20–71 years) had normo-/hypercoagulable ROTEM. There were significant differences in the total amount of fresh frozen plasma (FFP) transfused and FFP transfused per patient between the two groups (9,000 vs. 4,500 mL and 2,000 vs. 1,000 mL; p = 0.04, respectively). Two patients with hypocoagulable ROTEM bled within 30 days, while none did in the comparator group ( p = 0.03). One patient in the hypocoagulable group died within 30 days and none in the normo-/hypercoagulable group. Conclusion The use of ROTEM reduces FFP requirement in patients without liver disease with deranged PT/aPTT undergoing therapeutic endoscopic procedures without any increased risk of early or late rebleeding, and 30-day mortality.

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旋转血栓弹性测量可减少接受治疗性内镜手术的无肝病患者对新鲜冰冻血浆的需求--一项试点研究

摘要背景/目的旋转血栓弹性测试（ROTEM）是一种粘弹性测试，用于肝病患者指导血液成分的使用。本研究旨在比较接受治疗性内窥镜手术的无肝病患者在接受和未接受低凝血度 ROTEM 检查时，因检查凝血试验（凝血酶原时间 [PT]；活化部分凝血活酶时间 [aPTT]）失常而输注的血液制品量和出血率。方法对 2020 年至 2022 年期间接受治疗性内镜干预的 PT 和 aPTT 异常且无肝病的患者进行回顾性分析。记录了患有和未患有低凝性 ROTEM 患者的基线参数、输血产品数量以及 30 天出血率和死亡率等结果。结果在研究期间接受治疗性内镜检查的 204 名 PT/aPTT 异常患者中，有 180 名肝病患者被排除在外。6名患者（男：女=5:1；中位年龄：37岁，20-54岁）患有低凝ROTEM，18名患者（男：女=11:7；中位年龄：56岁，20-71岁）患有正常/高凝ROTEM。两组患者输注的新鲜冰冻血浆（FFP）总量和人均 FFP 输注量存在明显差异（分别为 9,000 对 4,500 毫升和 2,000 对 1,000 毫升；P = 0.04）。有两名低凝血ROTEM患者在30天内出血，而对比组患者无一人出血（P = 0.03）。低凝组有一名患者在 30 天内死亡，而正常/高凝组则无一人死亡。结论在接受治疗性内窥镜手术的无肝病且 PT/aPTT 异常的患者中，使用 ROTEM 可减少对 FFP 的需求，而不会增加早期或晚期再出血的风险以及 30 天内的死亡率。

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来源期刊

Journal of Digestive Endoscopy GASTROENTEROLOGY & HEPATOLOGY-

自引率

28.60%

发文量

审稿时长

22 weeks

期刊介绍： The Journal of Digestive Endoscopy (JDE) is the official publication of the Society of Gastrointestinal Endoscopy of India that has over 1500 members. The society comprises of several key clinicians in this field from different parts of the country and has key international speakers in its advisory board. JDE is a double-blinded peer-reviewed, print and online journal publishing quarterly. It focuses on original investigations, reviews, case reports and clinical images as well as key investigations including but not limited to cholangiopancreatography, fluoroscopy, capsule endoscopy etc.