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

Table 5 Thresholds for coagulation parameters prior to high-risk procedures in patients with cirrhosis

Parameters	EASL 2022	ISTH 2021	AASLD 2021	AGA 2021
PT/INR	Against routine evaluation and correction	Against correction	Against correction	Against routine evaluation and correctiona
Platelet count	Against correctionb	Against correctionb	Against correction	Against routine evaluation and correctiona
Fibrinogen	Against routine correction	Against routine evaluation	Against correction	No specific recommendation
TEG	Against routine evaluationc	Do not use routinely	Do not use routinely	No specific recommendation

^aIn case of severe coagulopathy, prophylactic blood transfusions should be considered on case-to-case basis by evaluating potential benefits and risks in consultation with a hematologist.

^bIf the bleeding cannot be controlled by the local hemostasis method, administration of platelet concentrate or thrombopoietin receptor agonist can be considered if the platelet count is < 50000 × 10⁶/L.

^cMay provide a baseline coagulation status and guide in the case of bleeding events.

AASLD: American Association for the Study of Liver Diseases; AGA: American Gastroenterological Association; EASL: European Association for the Study of the Liver; INR: International normalized ratio; ISTH: International Society on Thrombosis and Hemostasis; PT: Prothrombin time; TEG: Thromboelastography.