Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jan;104(1):15-25.
doi: 10.1111/ejh.13342. Epub 2019 Nov 19.

Transfusion strategies in patients with cirrhosis

Patricia Liu  1 , Justine Hum  2 , Janice Jou  2 , Richard M Scanlan  3 , Joseph Shatzel  4
Affiliations
Review

Transfusion strategies in patients with cirrhosis

Patricia Liu et al. Eur J Haematol. 2020 Jan.

Abstract

Bleeding related to portal hypertension and coagulopathy is a common complication in patients with cirrhosis. Complications and management of bleeding is a significant source of healthcare cost and utilization, as well as morbidity and mortality. Due to the scarcity of evidence surrounding transfusion strategies and hemostatic interventions in patients with cirrhosis, there has been significant debate regarding the best practice. Emerging data suggest that evidence supporting transfusion of packed red blood cells to a hemoglobin threshold of 7-8 g/dL is strong. thrombopoietin (TPO) receptor agonists have shown promise in increasing platelet levels and reducing transfusions preprocedurally, although have not specifically been found to reduce bleeding risk. Data for viscoelastic testing (VET)-guided transfusions appear favorable for reducing blood transfusion requirements prior to minor procedures and during orthotopic liver transplantation. Hemostatic agents such as recombinant factor VIIa, prothrombin complex concentrates, and tranexamic acid have been examined but their role in cirrhotic patients is unclear. Other areas of growing interest include balanced ratio and whole blood transfusion. In the following manuscript, we summarize the most up to date evidence for threshold-guided, VET-guided, balanced-ratio, and whole blood transfusions as well as the use of hemostatic agents in cirrhotic patients to provide practice guidance to clinicians.

Keywords: blood coagulation disorders; blood component transfusion; gastrointestinal hemorrhage; liver cirrhosis; viscoelastic testing.

PubMed Disclaimer

Conflict of interest statement

CONFLIC T OF INTEREST

None.

Figures

FIGURE 1
FIGURE 1
Factors provided by prothrombin complex concentrates and recombinant factor VIIa within the coagulation cascade
FIGURE 2
FIGURE 2
Sample thromboelastography (TEG) tracing
See this image and copyright information in PMC

References

    1. Tielleman T, Bujanda D, Cryer B. Epidemiology and risk factors for upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):415–428. - PubMed
    1. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD, Practice Guidelines Committee of American Association for Study of Liver D, Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086–2102. - PubMed
    1. Sharara AI, Rockey DC. Gastroesophageal variceal hemorrhage. N Engl J Med. 2001;345(9):669–681. - PubMed
    1. Shatzel J, Dulai PS, Harbin D, et al. Safety and efficacy of pharmacological thromboprophylaxis for hospitalized patients with cirrhosis: a single-center retrospective cohort study. J Thromb Haemost. 2015;13(7):1245–1253. - PMC - PubMed
    1. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–156. - PubMed

MeSH terms