ROTEM-guided blood product transfusion in patients with cirrhosis having invasive procedures: a randomized controlled trial
In brief
ROTEM guidance cuts prophylactic transfusions from 97% to 71% in cirrhosis procedures
In this small randomized trial, a rotational clotting test guided transfusions before invasive procedures in people with cirrhosis, reducing the share of procedures with prophylactic blood products from 97% to 71%. No major bleeding or differences in other safety outcomes were recorded, but the trial was too small to rule out uncommon harms.
- Journal
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Q1)
- Published
- 20 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Natasha Janko, William Kemp, Simone I Strasser, Marcus Robertson, Fadak Mohammadi, Rohit Sawhney, et al.
- PMID
- 42624392
- DOI
- 10.1016/j.cgh.2026.07.038
Why clinicians should know about it
- Picked for Hematology (top studies of the week, 25 October 2026): ROTEM‑guided transfusion reduces blood product use in cirrhosis patients
Abstract
BACKGROUND & AIMS: Peri-procedural blood component(s) prophylaxis is common in patients with cirrhosis undergoing invasive procedures. We evaluated whether a rotational thromboelastometry (ROTEM)-guided algorithm could reduce prophylactic transfusions without increasing bleeding complications. METHODS: In this randomized controlled trial, adults with cirrhosis scheduled for invasive procedures with abnormal INR and/or platelet count values requiring preprocedural correction as per standard local practice were randomized 1:1 to a ROTEM-guided or standard-of-care (SOC) transfusion strategy. The primary efficacy outcome was the proportion of procedures that required prophylactic transfusion of blood components(s). The primary safety outcome was major procedure-related bleeding. Secondary outcomes included type and volume of blood products transfused, transfusion reactions, thrombosis, and 28-day mortality. RESULTS: A total of 114 procedures in 99 patients were screened with 57 randomized (28 in ROTEM, 29 in SOC). 44 procedures (77%) were classified as having a high bleeding risk. Prophylactic blood products were administered before 20 procedures in the ROTEM group compared to 28 in the SOC group (71% vs. 97%, p<0.01). The pattern of blood product use differed between the groups, with less FFP and more cryoprecipitate in the ROTEM group than in the SOC group. There was no difference in procedure-related bleeding (no major bleeding was recorded), thrombosis, transfusion-related complications, length of stay, or mortality between the two groups. CONCLUSIONS: ROTEM-guided transfusion significantly reduced blood product use without compromising safety in cirrhosis patients undergoing invasive procedures. These findings support a more conservative, goal-directed approach to periprocedural hemostatic management in patients with cirrhosis.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.