Andrea Boccatonda, Elena Campello, Angela Napolitano, Antonella Bray, Chiara Simion, Carla Serra, Fabio Piscaglia, Luca Spiezia, Paolo Simioni
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引用次数: 0
Abstract
Background and aims: Bleeding risk in cirrhotic patients undergoing invasive procedures is traditionally assessed using conventional coagulation tests, which poorly reflect the rebalanced haemostatic state of cirrhosis and often lead to unnecessary transfusions. Viscoelastic testing (VET) provides a global assessment of coagulation and may enable more rational transfusion strategies. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to evaluate the efficacy and safety of VET-guided transfusion strategies in this setting.
Methods: We systematically searched PubMed, Embase and Scopus from inception to 10 April 2026. RCTs comparing VET-guided versus standard-of-care transfusion strategies in cirrhotic patients undergoing invasive procedures were included. Primary outcome was procedure-related bleeding; secondary outcomes included transfusion requirements. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method.
Results: Six RCTs including 296 patients were analysed. Procedure-related bleeding was rare and did not differ between groups (RR 0.74, 95% CI 0.24-2.31; I2 = 0%). In contrast, 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%), any fresh frozen plasma (FFP) exposure (RR 0.40, 95% CI 0.28-0.57; I2 = 63%) and FFP-only transfusion (RR 0.22, 95% CI 0.10-0.46; I2 = 81%).
Conclusions: VET-guided transfusion strategies significantly reduce blood product utilisation without increasing bleeding risk in cirrhotic patients undergoing invasive procedures. These findings support a shift towards a physiology-based approach to haemostasis, with potential benefits for patient safety and resource optimisation.
期刊介绍：
Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.
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