Approach to thromboelastography-based transfusion in cirrhosis: An alternative perspective on coagulation disorders

Core Tip

Core Tip: Viscoelastic hemostatic assays are increasingly used as “point-of-care” tests, providing real-time, dynamic insight into the complex coagulation aberrations seen in cirrhotic patients. In cirrhosis, all patients undergoing a high-risk invasive procedure or who are actively bleeding should undergo thromboelastography (TEG) on initial evaluation, if this testing is available. Any reasonable TEG-based strategy will likely represent an improvement over strategies using traditional coagulation tests. The best approach will be to use TEG supplemented by standard platelet count and fibrinogen testing. TEG is a promising diagnostic modality and may help in predicting bleeding and aid in the rationalization of the use of blood products in these patients.