Comparison of three transfusion protocols prior to central venous catheterization in patients with cirrhosis: A randomized controlled trial
| Autor: | Roseny dos Reis Rodrigues, Roberto Rabello Filho, Murillo Santucci Cesar de Assunção, Leonardo Lima Rocha, Bianca Della Guardia, Eliezer Silva, Marcio Dias de Almeida, Ary Serpa Neto, Camila Menezes Souza Pessoa, Tomaz Crochemore, Renato Carneiro de Freitas Chaves, Rogerio Ruscitto do Prado, Ana Maria Cavalheiro, Nicole P. Juffermans, Thiago Domingos Corrêa |
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| Přispěvatelé: | Intensive Care Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Catheterization Central Venous Blood transfusion medicine.medical_treatment liver cirrhosis Hemorrhage 030204 cardiovascular system & hematology law.invention blood coagulation 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Clinical endpoint Humans Blood Transfusion Adverse effect business.industry thromboelastography Hematology Odds ratio Middle Aged Confidence interval Thrombelastography critical care Anesthesia Cryoprecipitate Female Fresh frozen plasma business central venous catheters |
| Zdroj: | Journal of thrombosis and haemostasis, 18(3), 560-570. Wiley-Blackwell |
| ISSN: | 1538-7933 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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