Gopal Nimi, Panwar Shivali, Saluja Vandana, Garg Neha, Gupta Surbhi, Kumar Guresh, Maiwall Rakhi
Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Anaesthesia and Critical Care, Amrita Hospital, Faridabad, Haryana, India.
Int J Crit Illn Inj Sci. 2024 Apr-Jun;14(2):67-73. doi: 10.4103/ijciis.ijciis_65_23. Epub 2024 Jun 21.
Viscoelastic tests are now routinely used for coagulopathy correction in patients with cirrhosis. Thromboelastography (TEG) and rotational thromboelastometry (RoTEM®) are the most widely studied tests in this population. However, they have not been compared with each other in critically ill patients with liver disease presenting with nonvariceal bleed. Hence, we aimed to compare these tests for coagulopathy correction in patients with liver disease presenting with nonvariceal bleeding.
Sixty adult patients with liver cirrhosis presented to the liver intensive care unit, presenting with a nonvariceal upper gastrointestinal (GI) bleed (diagnosed by doing upper GI endoscopy which revealed bleeding from a nonvariceal source) oral or nasal bleed were enrolled. The patients were allocated to the TEG group (Group T) or RoTEM group (Group R) depending on the immediate availability of the viscoelastic test. Coagulopathy correction was done in each group as per established protocols and the results were compared.
There was a significant difference in the fresh frozen plasma (FFP) transfusion between the groups. The TEG group received more FFP when compared to the RoTEM group ( = 0.001).
RoTEM-based coagulopathy correction leads to lesser use of blood products with similar control of bleeding when compared to TEG, in critically ill patients with cirrhosis.
目前，粘弹性检测已常规用于肝硬化患者凝血功能障碍的纠正。血栓弹力图（TEG）和旋转血栓弹力测定法（ROTEM®）是该人群中研究最为广泛的检测方法。然而，对于出现非静脉曲张出血的重症肝病患者，尚未对这两种检测方法进行相互比较。因此，我们旨在比较这两种检测方法在出现非静脉曲张出血的肝病患者中纠正凝血功能障碍的效果。
60例肝硬化成年患者入住肝脏重症监护病房，均出现非静脉曲张性上消化道（GI）出血（通过上消化道内镜检查诊断，显示出血来自非静脉曲张来源）或口腔或鼻腔出血，将其纳入研究。根据粘弹性检测的即时可用性，将患者分配到TEG组（T组）或ROTEM组（R组）。每组均按照既定方案进行凝血功能障碍的纠正，并比较结果。
两组之间新鲜冰冻血浆（FFP）输注量存在显著差异。与ROTEM组相比，TEG组接受的FFP更多（P = 0.001）。
在肝硬化重症患者中，与TEG相比，基于ROTEM的凝血功能障碍纠正导致血液制品使用量减少，且出血控制效果相似。
