Rotational thromboelastometry‐guided blood component use in cirrhotic children undergoing invasive procedures: Randomized controlled trial

• Published in: Liver international 2022-11, Vol.42 (11), p.2492-2500
• Main Authors: Maria, Arjun, Lal, Bikrant B., Khanna, Rajeev, Sood, Vikrant, Mukund, Amar, Bajpai, Meenu, Alam, Seema
• Format: Article
• Language: English
• Subjects: Biopsy; Blood transfusion; Children; Cirrhosis; Clinical trials; Complications; cost‐effectiveness; invasive procedures in cirrhotic children; Liver; liver biopsy; Liver cirrhosis; Platelets; Randomization; rotational thromoelastometry; ROTEM‐guided blood component transfusion; Strategy; Transfusion; viscoelastic tests in cirrhotic children
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.15398

Background & Aims This randomized controlled trial (RCT) was conducted with the aim to evaluate the efficacy and safety of using ROTEM‐based transfusion strategy in cirrhotic children undergoing invasive procedures. Methods This was an open‐label, RCT which included (i) children under 18 years of age with liver cirrhosis; (ii) INR between 1.5 and 2.5; and/or (iii) platelet count between 20 × 109/L and 50 × 109/L (for procedures other than liver biopsy) and between 40 × 109/L and 60 × 109/L (for liver biopsy); and (iv) listed for invasive procedures. Stratified randomization was done for children undergoing liver biopsies. Patients randomized to the ROTEM and conventional groups received blood component transfusion using predefined criteria. Results A total of 423 invasive procedures were screened for inclusion of which 60 were randomized (30 in each group with comparable baseline parameters). The volume of total blood components, fresh frozen plasma (FFP) and platelets transfused was significantly lower in ROTEM as compared to conventional group. Only 46.7% of children in ROTEM group received a blood component compared to 100% in conventional group (p