Rocha Leonardo L, Neto Ary S, Pessoa Camila M S, Almeida Márcio D, Juffermans Nicole P, Crochemore Tomaz, Rodrigues Roseny R, Filho Roberto R, de Freitas Chaves Renato Carneiro, Cavalheiro Ana M, Prado Rogério R, Assunção Murillo S C, Guardia Bianca D, Silva Eliézer, Corrêa Thiago D
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Department of Critical Care Medicine, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
J Thromb Haemost. 2020 Mar;18(3):560-570. doi: 10.1111/jth.14672. Epub 2019 Dec 2.
Transfusion of blood components prior to invasive procedures in cirrhosis patients is high and associated with adverse events.
We compared three transfusion strategies prior to central venous catheterization in cirrhosis patients.
PATIENTS/METHODS: Single center randomized trial that included critically ill cirrhosis patients with indication for central venous line in a tertiary private hospital in Brazil.
Restrictive protocol, thromboelastometry-guided protocol, or usual care (based on coagulogram). The primary endpoint was the proportion of patients transfused with any blood component (ie, fresh frozen plasma, platelets, or cryoprecipitate). The secondary endpoints included incidence of bleeding and transfusion-related adverse events.
A total of 57 patients (19 per group; 64.9% male; mean age, 53.4 ± 11.3 years) were enrolled. Prior to catheterization, 3/19 (15.8%) in the restrictive arm, 13/19 (68.4%) in the thromboelastometry-guided arm, and 14/19 (73.7%) in the coagulogram-guided arm received blood transfusion (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-0.45; P = .002 for restrictive versus coagulogram-guided arm; OR, 0.09; 95% CI, 0.01-0.56; P = .006 for restrictive versus thromboelastometry-guided arm; and OR, 0.77; 95% CI, 0.14-4.15; P = .931 for thromboelastometry-guided versus coagulogram-guided arm). The restrictive protocol was cost saving. No difference in bleeding, length of stay, mortality, and transfusion-related adverse events was found.
The use of a restrictive strategy is associated with a reduction in transfusion prior to central venous catheterization and costs in critically ill cirrhosis patients. No effect on bleeding was found among the groups.
肝硬化患者在侵入性操作前的血液成分输血率很高，且与不良事件相关。
我们比较了肝硬化患者中心静脉置管前的三种输血策略。
患者/方法：这是一项单中心随机试验，纳入了巴西一家三级私立医院中具有中心静脉置管指征的重症肝硬化患者。
限制性方案、血栓弹力图引导方案或常规治疗（基于凝血图）。主要终点是接受任何血液成分（即新鲜冰冻血浆、血小板或冷沉淀）输血的患者比例。次要终点包括出血发生率和输血相关不良事件。
共纳入57例患者（每组19例；男性占64.9%；平均年龄53.4±11.3岁）。置管前，限制性组中有3/19（15.8%）、血栓弹力图引导组中有13/19（68.4%）、凝血图引导组中有14/19（73.7%）接受了输血（比值比[OR]为0.07；95%置信区间[CI]为0.01 - 0.45；限制性组与凝血图引导组相比，P = 0.002；OR为0.09；95% CI为0.01 - 0.56；限制性组与血栓弹力图引导组相比，P = 0.006；血栓弹力图引导组与凝血图引导组相比，OR为0.77；95% CI为0.14 - 4.15；P = 0.931）。限制性方案节省成本。在出血、住院时间、死亡率和输血相关不良事件方面未发现差异。
在重症肝硬化患者中，采用限制性策略与中心静脉置管前输血减少及成本降低相关。各组之间未发现对出血有影响。
