Azer Amanda, Panayotova Guergana G, Kong Karen, Hakakian Daniel, Sheikh Fariha, Gorman Elizabeth, Sutherland Anne, Tafesh Zaid, Horng Helen, Guarrera James V, Glass Nina E
Division of Trauma and Critical Care Surgery, Department of Surgery, Rutgers NJMS, Newark, New Jersey.
Division of Transplant and HPB Surgery, Department of Surgery, Rutgers, NJMS, Newark, New Jersey.
J Surg Res. 2023 Jul;287:142-148. doi: 10.1016/j.jss.2023.02.004. Epub 2023 Mar 16.
Thromboelastography (TEG) is a functional test of coagulation used to guide transfusions. Despite literature supporting its utility, its use remains limited to select populations. In patients with cirrhosis, conventional coagulation tests are notoriously inaccurate, and TEG may be a better measure of coagulopathy. We aimed to assess the utilization of TEG in patients with cirrhosis to steward blood transfusions in this high-risk group.
A single-center retrospective chart review of all patients ≥18 y old with a diagnosis of liver cirrhosis who had TEG results documented in the electronic medical record from January 1 to November 1, 2021.
There were 277 TEG results on 89 patients with cirrhosis. Overall, 91% of the TEGs performed were associated with a clinical indication for transfusion. However, of the patients who were transfused, abnormal TEG values, including elevated R time and reduced maximum amplitude, did not correspond to transfusion of indicated blood products (fresh frozen plasma and platelets). A reduction in alpha angle showed a statistically significant association with transfusion of cryoprecipitate (P < 0.05). When assessing conventional coagulation tests, abnormal values were not significantly associated with transfusion (P = 0.07).
Despite TEG suggesting that transfusions could be avoided in many cirrhotic patients, patients are still being transfused platelets and fresh frozen plasma in the absence of evidence of coagulopathy on TEG. Our finding suggests the need for education about appropriate utilization of TEG. More research is needed to understand the role of these tests to guide transfusion practices in patients with cirrhosis.
血栓弹力图（TEG）是一种用于指导输血的凝血功能检测。尽管有文献支持其效用，但其使用仍仅限于特定人群。在肝硬化患者中，传统凝血检测 notoriously 不准确，而TEG可能是评估凝血病的更好方法。我们旨在评估TEG在肝硬化患者中的应用，以管理这一高危人群的输血。
对2021年1月1日至11月1日在电子病历中有TEG结果记录的所有年龄≥18岁的肝硬化诊断患者进行单中心回顾性病历审查。
89例肝硬化患者有277次TEG结果。总体而言，所进行的TEG检测中有91%与输血的临床指征相关。然而，在接受输血的患者中，异常的TEG值，包括R时间延长和最大振幅降低，与输注指定血液制品（新鲜冰冻血浆和血小板）并不对应。α角降低与冷沉淀输注有统计学显著关联（P<0.05）。在评估传统凝血检测时，异常值与输血无显著关联（P=0.07）。
尽管TEG表明许多肝硬化患者可避免输血，但在TEG无凝血病证据的情况下，患者仍在输注血小板和新鲜冰冻血浆。我们的发现表明需要对TEG的适当应用进行教育。需要更多研究来了解这些检测在指导肝硬化患者输血实践中的作用。
