(1364) Thromboelastography-Aided Transfusion in Gastrointestinal Bleeding

Introduction: Gastrointestinal bleeding (GIB) is a common diagnosis requiring ICU admission, with a mortality rate ranging from 2-17%. Hemorrhagic shock is a severe complication of GIB treated with transfusions of blood products targeted at restoring hemoglobin and avoiding coagulopathies. Most centers utilize transfusion protocols to guide resuscitation in trauma-related bleeding. Routine use of these protocols remains controversial in the medical population. Thromboelastography (TEG)-aided resuscitation has been shown to decrease ICU length of stay (LOS) and improve utilization of blood products in cirrhotic patients. In this study, we describe a cohort of patients with GIB where TEG was utilized, focusing on patient-centered outcomes, such as blood product utilization, ICU LOS and in-hospital mortality.

Methods: A retrospective cohort analysis of patients presenting with GIB admitted to an ICU at a tertiary care center between 2017-2020 in whom a TEG was reported. Medical records were reviewed for pertinent medical history, vital signs, laboratory values, need for vasopressors, number of blood units transfused, ICU LOS, and mortality. Patients were excluded if they were admitted to a pediatric ICU or were admitted for trauma.

Results: A total of 226 patients were included. Mean age of the cohort was 61 years and 65% were males. The most common comorbidities were alcohol use (31%), esophageal varices (30%), and peptic ulcer disease (27%). 29% of patients were on PPI therapy prior to admission. Patients had a mean nadir MAP of 51 mmHg within 48 hours of presentation. Mean nadir hemoglobin was 6.50 g/dl. 70% of patients required vasopressor support, and 20% needed emergent surgical intervention. Patients received a mean of 6.0 pRBC, 0.8 platelets, 1.8 FFP, and 0.6 cryoprecipitate units. The mean ICU LOS was 5 days. The observed mortality rate was 39%.

Conclusions: We describe a cohort of patients with GIB, many of whom had concurrent hemorrhagic shock. Observed mortality rate was 39%, which is higher than previously reported rates. The ratio of transfused product was discordant from the commonly cited 1:1:1 ratio of RBCs, platelets, and FFP. Our findings suggest that TEG usage is associated with higher severity of illness or that it leads to deviation from previously described protocols with worse outcomes.