J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 10-11, December 2023, pages 431-437

A Retrospective Study Comparing the Effect of Conventional Coagulation Parameters Vs. Thromboelastography-Guided Blood Product Utilization in Patients With Major Gastrointestinal Bleeding

Figure 1. The patient inclusion in study flow chart. GI: gastrointestinal; ICU: intensive care unit; TEG: thromboelastography.

**Table 1.** Baseline Variables of Study Population and Cirrhosis Sub-Group and Evaluation of Differences Between TEG and Non-TEG Group
Patient demographics	TEG group (n = 44)	Non-TEG group (n = 44)	P-value	TEG cirrhosis sub-group (n = 23)	Non-TEG cirrhosis sub-group (n = 23)	P-value	Test of significance
aPTT: activated partial thromboplastin time; ICU: intensive care unit; INR: international normalized ratio; IV: intravenous; LOS: length of stay; SOFA: sequential organ failure assessment; TEG: thromboelastography.
Age (mean)	56.5	57.7	0.66	52	51	0.79	t-test
Gender							Chi-square test
Male (%)	63.6	52.3	0.28	61	70	0.54
Female (%)	36.4	47.7		39	30
Race							Chi-square test
Caucasian	95.5	95.5	1.0	91.3	91.3	1.0
Comorbidities
Diabetes (%)	40.9	43.2	0.83	30.4	39.1	0.54	Chi-square test
Hypertension (%)	43.2	43.2	1.00	43.5	52.2	0.56	Chi-square test
Chronic kidney disease (%)	31.8	25	0.48	30.4	22.0	0.50	Chi-square test
Congestive heart failure (%)	11.4	6.8	0.46	4.3	0.0	0.31	Chi-square test
Hepatic encephalopathy (%)	6.8	6.8	1.00	13	13	1.00	Fisher’s exact test
Ascites (%)	22.7	27.3	0.62	17.4	21.7	0.71	Chi-square test
Laboratory values
Sodium (mean)	140 mEq/L	141 mEq/L	0.44	140 mEq/L	138 mEq/L	0.43	t-test
Blood urea nitrogen (mean)	41.39 mg/dL	39.73 mg/dL	0.33	37 mg/dL	36 mg/dL	0.56	Mann-Whitney U test
Creatinine (mean)	1.86 mg/dL	1.82 mg/dL	0.51	1.7 mg/dL	1.8 mg/dL	0.90	Mann-Whitney U test
Hemoglobin (mean)	7.8 mg/dL	8.0 mg/dL	0.65	7.8 mg/dL	8.2 mg/dL	0.95	t-test
Platelet (mean)	1.22 × 10⁵/µL	1.27 × 10⁵/µL	0.71	7.4 × 10⁴/µL	8.8 × 10⁴/µL	0.95	Mann-Whitney U test
INR (mean)	2.12	2.01	0.98	2.4	2.3	0.92	Mann-Whitney U test
aPTT (mean)	44 s	43 s	0.93	47 s	45 s	0.92	Mann-Whitney U test
Albumin (mean)	2.0 g/dL	2.0 g/dL	0.98	2.1 g/dL	2.1 g/dL	0.52	t-test
Bilirubin (mean)	4.8 mg/dL	3.9 mg/dL	0.28	7.1 mg/dL	6 mg/dL	0.38	Mann-Whitney U test
Hospital anticoagulation use
Anti-platelets (%)	18.2	9.1	0.21	13	8.7	1.00	Fisher’s exact test
Enoxaparin (%)	27.3	29.5	0.81	4.3	4.3	1.00	Chi-square test
Heparin drip (%)	6.8	6.8	1.00	4.3	0.0	1.00	Fisher’s exact test
Heparin subcutaneous (%)	43.2	31.8	0.27	26	14	0.47	Chi-square test
Home beta-blocker use
Propranolol (%)	2.3	2.3	1.00	4.3	8.7	1.00	Fisher’s exact test
Nadolol (%)	6.8	9.1	1.00	13	4.3	0.61	Fisher’s exact test
SOFA score (mean)	11	10.8	0.66	12.6	12.6	0.96	t-test
Proton pump inhibitor use
IV pantoprazole twice a day (%)	70.5	61.4	0.37	52.2	52.2	1.00	Chi-square test
Pantoprazole drip (%)	77.3	65.9	0.24	87	83	1.00	Fisher’s exact test
Octreotide drip use (%)	77.3	65.9	0.60	91.3	100	0.50	Fisher’s exact test
ICU LOS in days (mean)	19	12	0.56	11.3	8.04	0.62	Mann-Whitney U test
Hospital LOS in days (mean)	29.64	18.89	0.56	18	15	0.76	Mann-Whitney U test
Ventilator days (mean)	16	9	0.81	10	7	0.73	Mann-Whitney U test
Vasopressor use (%)	86.4	79.5	0.40	91.3	82.6	0.38	Chi-square test

Table 1. Baseline Variables of Study Population and Cirrhosis Sub-Group and Evaluation of Differences Between TEG and Non-TEG Group

Patient demographics

TEG group (n = 44)

Non-TEG group (n = 44)

P-value

TEG cirrhosis sub-group (n = 23)

Non-TEG cirrhosis sub-group (n = 23)

P-value

Test of significance

aPTT: activated partial thromboplastin time; ICU: intensive care unit; INR: international normalized ratio; IV: intravenous; LOS: length of stay; SOFA: sequential organ failure assessment; TEG: thromboelastography.

Age (mean)

56.5

57.7

0.66

0.79

t-test

Gender

Chi-square test

Male (%)

63.6

52.3

0.28

0.54

Female (%)

36.4

47.7

Race

Chi-square test

Caucasian

95.5

1.0

91.3

1.0

Comorbidities

Diabetes (%)

40.9

43.2

0.83

30.4

39.1

0.54

Chi-square test

Hypertension (%)

43.2

1.00

43.5

52.2

0.56

Chi-square test

Chronic kidney disease (%)

31.8

0.48

30.4

22.0

0.50

Chi-square test

Congestive heart failure (%)

11.4

6.8

0.46

4.3

0.0

0.31

Chi-square test

Hepatic encephalopathy (%)

6.8

1.00

Fisher’s exact test

Ascites (%)

22.7

27.3

0.62

17.4

21.7

0.71

Chi-square test

Laboratory values

Sodium (mean)

140 mEq/L

141 mEq/L

0.44

140 mEq/L

138 mEq/L

0.43

t-test

Blood urea nitrogen (mean)

41.39 mg/dL

39.73 mg/dL

0.33

37 mg/dL

36 mg/dL

0.56

Mann-Whitney U test

Creatinine (mean)

1.86 mg/dL

1.82 mg/dL

0.51

1.7 mg/dL

1.8 mg/dL

0.90

Mann-Whitney U test

Hemoglobin (mean)

7.8 mg/dL

8.0 mg/dL

0.65

7.8 mg/dL

8.2 mg/dL

0.95

t-test

Platelet (mean)

1.22 × 10⁵/µL

1.27 × 10⁵/µL

0.71

7.4 × 10⁴/µL

8.8 × 10⁴/µL

0.95

Mann-Whitney U test

INR (mean)

2.12

2.01

0.98

2.4

2.3

0.92

Mann-Whitney U test

aPTT (mean)

44 s

43 s

0.93

47 s

45 s

0.92

Mann-Whitney U test

Albumin (mean)

2.0 g/dL

0.98

2.1 g/dL

0.52

t-test

Bilirubin (mean)

4.8 mg/dL

3.9 mg/dL

0.28

7.1 mg/dL

6 mg/dL

0.38

Mann-Whitney U test

Hospital anticoagulation use

Anti-platelets (%)

18.2

9.1

0.21

8.7

1.00

Fisher’s exact test

Enoxaparin (%)

27.3

29.5

0.81

4.3

1.00

Chi-square test

Heparin drip (%)

6.8

1.00

4.3

0.0

1.00

Fisher’s exact test

Heparin subcutaneous (%)

43.2

31.8

0.27

0.47

Chi-square test

Home beta-blocker use

Propranolol (%)

2.3

1.00

4.3

8.7

1.00

Fisher’s exact test

Nadolol (%)

6.8

9.1

1.00

4.3

0.61

Fisher’s exact test

SOFA score (mean)

10.8

0.66

12.6

0.96

t-test

Proton pump inhibitor use

IV pantoprazole twice a day (%)

70.5

61.4

0.37

52.2

1.00

Chi-square test

Pantoprazole drip (%)

77.3

65.9

0.24

1.00

Fisher’s exact test

Octreotide drip use (%)

77.3

65.9

0.60

91.3

100

0.50

Fisher’s exact test

ICU LOS in days (mean)

0.56

11.3

8.04

0.62

Mann-Whitney U test

Hospital LOS in days (mean)

29.64

18.89

0.56

0.76

Mann-Whitney U test

Ventilator days (mean)

0.81

0.73

Mann-Whitney U test

Vasopressor use (%)

86.4

79.5

0.40

91.3

82.6

0.38

Chi-square test

**Table 2.** Primary and Secondary Outcomes of TEG and Non-TEG Group Along With Cirrhosis Sub-Group
	TEG group (n = 44)	Non-TEG group (n = 44)	P-value	TEG cirrhosis sub-group (n = 23)	Non-TEG cirrhosis sub-group (n = 23)	P-value	Test of significance used
GI: gastrointestinal; RBC: red blood cell; TEG: thromboelastography; TIPS: transjugular intrahepatic portosystemic shunt.
Primary outcomes
Total RBC transfused (mL)	2,549	1,274	0.21	2,615	632	0.07	Mann-Whitney U test
Total plasma transfused (mL)	1,036	913	0.13	1,601	1,127	0.17	Mann-Whitney U test
Total cryoprecipitate transfused (mL)	80	55	0.03	136	162	0.17	Mann-Whitney U test
Total platelets transfused (mL)	543	327	0.02	791	327	0.07	Mann-Whitney U test
Total blood volume transfused (mL)	4,207	2,568	0.04	5,144	2,248	0.06	Mann-Whitney U test
Secondary outcomes
Pre-intervention RBC transfused (mL)	390	48	0.23	263	104	0.58	Mann-Whitney U test
Pre-intervention plasma transfused	247	124	0.94	436	189	0.75	Mann-Whitney U test
Pre-intervention cryoprecipitate transfused (mL)	8	32	0.56	15	63	0.56	Mann-Whitney U test
Pre-intervention platelets transfused (mL)	163	42	0.63	279	108	0.28	Mann-Whitney U test
Pre-intervention blood volume transfused	807	246	0.62	993	465	0.83	Mann-Whitney U test
Total upper GI endoscopies	0.75	0.89	0.10	0.61	0.87	0.05	Mann-Whitney U test
Total colonoscopies	0.11	0.05	0.24	0.04	0.13	0.3	Mann-Whitney U test
Total embolization	0.36	0.30	0.50	0.17	0.26	0.48	Mann-Whitney U test
Total TIPS	0.11	0.11	1.00	0.13	0.13	1.00	Mann-Whitney U test
Total procedures for bleeding	1.34	1.34	0.92	0.06	1.39	0.06	Mann-Whitney U test

Table 2. Primary and Secondary Outcomes of TEG and Non-TEG Group Along With Cirrhosis Sub-Group

TEG group (n = 44)

Non-TEG group (n = 44)

P-value

TEG cirrhosis sub-group (n = 23)

Non-TEG cirrhosis sub-group (n = 23)

P-value

Test of significance used

GI: gastrointestinal; RBC: red blood cell; TEG: thromboelastography; TIPS: transjugular intrahepatic portosystemic shunt.

Primary outcomes

Total RBC transfused (mL)

2,549

1,274

0.21

2,615

632

0.07

Mann-Whitney U test

Total plasma transfused (mL)

1,036

913

0.13

1,601

1,127

0.17

Mann-Whitney U test

Total cryoprecipitate transfused (mL)

0.03

136

162

0.17

Mann-Whitney U test

Total platelets transfused (mL)

543

327

0.02

791

327

0.07

Mann-Whitney U test

Total blood volume transfused (mL)

4,207

2,568

0.04

5,144

2,248

0.06

Mann-Whitney U test

Secondary outcomes

Pre-intervention RBC transfused (mL)

390

0.23

263

104

0.58

Mann-Whitney U test

Pre-intervention plasma transfused

247

124

0.94

436

189

0.75

Mann-Whitney U test

Pre-intervention cryoprecipitate transfused (mL)

0.56

Mann-Whitney U test

Pre-intervention platelets transfused (mL)

163

0.63

279

108

0.28

Mann-Whitney U test

Pre-intervention blood volume transfused

807

246

0.62

993

465

0.83

Mann-Whitney U test

Total upper GI endoscopies

0.75

0.89

0.10

0.61

0.87

0.05

Mann-Whitney U test

Total colonoscopies

0.11

0.05

0.24

0.04

0.13

0.3

Mann-Whitney U test

Total embolization

0.36

0.30

0.50

0.17

0.26

0.48

Mann-Whitney U test

Total TIPS

0.11

1.00

0.13

1.00

Mann-Whitney U test

Total procedures for bleeding

1.34

0.92

0.06

1.39

0.06

Mann-Whitney U test