Home›Gastroenterology› Viscoelastic Testing Cuts Transfusions in Cirrhosis Procedures
Viscoelastic Testing Cuts Transfusions in Cirrhosis ProceduresNew testing method reduces blood transfusions for liver patients
Liver international : official journal of the International Association for the Study of the LiverPublished August 1, 2026Study authors: Boccatonda Andrea, Campello Elena, Napolitano Angela, Bray Antonella, Simion Chiara, Serra Carla, Pi…PubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
VET-guided transfusions reduce blood product use without increasing bleeding risk in cirrhosis procedures.
A meta-analysis of 296 patients with cirrhosis undergoing invasive procedures compared viscoelastic testing (VET)-guided transfusion strategies with standard-of-care transfusions. The primary outcome was procedure-related bleeding, which occurred rarely and showed no significant difference between groups (RR 0.74, 95% CI 0.24-2.31).
However, VET-guided strategies significantly reduced the need for any blood product transfusion (RR 0.33, 95% CI 0.26-0.44), platelet transfusion (RR 0.20, 95% CI 0.13-0.32), any fresh frozen plasma (FFP) exposure (RR 0.40, 95% CI 0.28-0.57), and FFP-only transfusion (RR 0.22, 95% CI 0.10-0.46).
These findings suggest that VET-guided transfusion strategies can markedly decrease blood product utilization without increasing bleeding risk. This is particularly relevant for patients with cirrhosis, who often have complex coagulation abnormalities and are at risk for both bleeding and thrombotic complications.
The meta-analysis included randomized controlled trials, allowing for causal inference. However, heterogeneity was moderate to high for some outcomes, and the overall certainty of evidence was not reported. Procedure-related bleeding was rare, which may limit the precision of the bleeding risk estimate.
In practice, adopting VET-guided transfusion protocols could reduce unnecessary transfusions, conserve resources, and minimize patient exposure to blood products. Further research should address optimal VET parameters and patient selection to maximize benefits.
How this fits prior evidence
This meta-analysis addresses a gap in managing blood product utilization during invasive procedures for patients with cirrhosis. It complements existing knowledge on management of liver disease, such as the use of endovascular interventions to reduce rebleeding risk and the role of hepatologist-led palliative care. While previous findings focused on pharmacological and surgical interventions for cirrhosis, this study specifically addresses intraoperative transfusion strategies.
Patients with cirrhosis often face complex risks when undergoing invasive medical procedures. One major concern is managing blood transfusions effectively to keep the patient stable while minimizing unnecessary treatments. A review of recent trials looked at using a specific testing method called viscoelastic testing (VET) to guide these transfusion decisions.
The study looked at 296 patients and compared this guided approach to standard care. The results showed that using VET-guided strategies significantly reduced the need for various blood products, including platelets and fresh frozen plasma. This means doctors could be more precise about when a patient actually needs a transfusion.
Importantly, while the amount of blood products given decreased significantly, there was no difference in the actual amount of bleeding during procedures between the two groups. This suggests that using this testing method can streamline care for liver patients without increasing their risk of complications.
What this means for you:
VET-guided testing reduces the need for blood transfusions in cirrhosis patients without increasing bleeding risks.
Common questions
How does this method change how patients are treated?
This method uses viscoelastic testing (VET) to guide doctors on when to give blood products. The study found that using this guided strategy significantly reduced the amount of platelets and fresh frozen plasma needed for patients with cirrhosis during invasive procedures.
Is it safer for the patient to use this method?
The study showed no significant difference in procedure-related bleeding between patients who received guided treatment and those who received standard care. This suggests that reducing the amount of blood products given does not increase the risk of bleeding during the procedure.
Which specific blood products were reduced?
The study found significant reductions in several areas: any blood product transfusion, platelet transfusions, and fresh frozen plasma (FFP) exposure. Specifically, FFP-only transfusions were also significantly reduced when using the guided strategy.
BACKGROUND AND AIMS: Bleeding risk in cirrhotic patients undergoing invasive procedures is traditionally assessed using conventional coagulation tests, which poorly reflect the rebalanced haemostatic state of cirrhosis and often lead to unnecessary transfusions. Viscoelastic testing (VET) provides a global assessment of coagulation and may enable more rational transfusion strategies. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to evaluate the efficacy and safety of VET-guided transfusion strategies in this setting.
METHODS: We systematically searched PubMed, Embase and Scopus from inception to 10 April 2026. RCTs comparing VET-guided versus standard-of-care transfusion strategies in cirrhotic patients undergoing invasive procedures were included. Primary outcome was procedure-related bleeding; secondary outcomes included transfusion requirements. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method.
RESULTS: Six RCTs including 296 patients were analysed. Procedure-related bleeding was rare and did not differ between groups (RR 0.74, 95% CI 0.24-2.31; I = 0%). In contrast, VET-guided strategies significantly reduced transfusion requirements, including any blood product transfusion (RR 0.33, 95% CI 0.26-0.44; I = 56%), platelet transfusion (RR 0.20, 95% CI 0.13-0.32; I = 40%), any fresh frozen plasma (FFP) exposure (RR 0.40, 95% CI 0.28-0.57; I = 63%) and FFP-only transfusion (RR 0.22, 95% CI 0.10-0.46; I = 81%).
CONCLUSIONS: VET-guided transfusion strategies significantly reduce blood product utilisation without increasing bleeding risk in cirrhotic patients undergoing invasive procedures. These findings support a shift towards a physiology-based approach to haemostasis, with potential benefits for patient safety and resource optimisation.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: CRD420261382437.
