TY - JOUR
T1 - Comparison of three transfusion protocols prior to central venous catheterization in patients with cirrhosis: A randomized controlled trial
AU - Rocha, Leonardo L.
AU - Neto, Ary S.
AU - Pessoa, Camila M. S.
AU - Almeida, M. rcio D.
AU - Juffermans, Nicole P.
AU - Crochemore, Tomaz
AU - Rodrigues, Roseny R.
AU - Filho, Roberto R.
AU - Chaves, Renato C. F.
AU - Cavalheiro, Ana M.
AU - Prado, Rogério R.
AU - Assunção, Murillo S. C.
AU - Guardia, Bianca D.
AU - Silva, Eliézer
AU - Corrêa, Thiago D.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background: Transfusion of blood components prior to invasive procedures in cirrhosis patients is high and associated with adverse events. Objectives: 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. Interventions: 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. Results: 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. Conclusions: 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.
AB - Background: Transfusion of blood components prior to invasive procedures in cirrhosis patients is high and associated with adverse events. Objectives: 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. Interventions: 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. Results: 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. Conclusions: 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.
KW - blood coagulation
KW - central venous catheters
KW - critical care
KW - liver cirrhosis
KW - thromboelastography
UR - http://www.scopus.com/inward/record.url?scp=85076128905&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jth.14672
DO - https://doi.org/10.1111/jth.14672
M3 - Article
C2 - 31667992
SN - 1538-7933
VL - 18
SP - 560
EP - 570
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 3
ER -