03:00 PM Abstract No. 33 Evaluating blood product utilization and bleeding complications after implementation of single institution’s restrictive guidelines for periprocedural management of coagulation status in percutaneous image-guided interventions

Abstract

Pre-procedure correction coagulopathy is of high priority in patients undergoing minimally invasive IR procedures. Unnecessary transfusion of blood products is associated with well-known infectious and non-infectious risks, however, uncorrected coagulopathy in the perioperative setting can be detrimental to the patient. Therefore, determining safe thresholds for administration of blood products is imperative, which in interventional radiology is mostly governed by the SIR consensus guidelines. The purpose of this study is to assess whether a single institution’s restrictive approach to pre-procedural transfusion of blood products can safely achieve outcomes similar to the established, more liberal guidelines. A total of 354 patients were enrolled in the study and a hypothetical comparison using Chi square method was made based on laboratory values that would have necessitated transfusion according to the SIR consensus guidelines (see table for transfusion cut-offs) Following our restrictive guidelines, high-risk group (n=119 patients), no FFP transfusion was required compared to 11 transfusions in the liberal group. Similarly, only 2 platelet transfusions were required in the restrictive group compared to 6 transfusions (p < 0.001) in the liberal group. In moderate-risk group (n=235 patients), there was statistically significant difference in the number of transfusions between the two strategies. Following our guidelines, only 1 FFP and 1 platelet transfusion were required compared to 26 FFP (p=0.004) and 7 platelet transfusions (p<0.003), respectively. Overall, in total of 354 patients, the number of FFP transfusion was only 1 in restrictive group compared to 37 in the liberal group (p = 0.003) and the number of platelet transfusion was only 3 compared to 13 in the liberal group (p<0.001). No difference in hemorrhagic complications was noted between patients receiving restrictive versus liberal transfusions. Restrictive transfusion strategy in patients undergoing IR procedures results in significant decrease in transfusions with no difference in hemorrhagic complications as well as drastic reduction in transfusion-related acquisition and activity-based costs.Tabled 1Transfusion Indications in Consensus GuidelinesTransfusion Indications in Restrictive Guidelines•Platelets ≤ 50,000•INR ≤ 1.5Non-cirrhotic Patients:•Platelets ≤ 30,000•INR ≤ 2.5Cirrhotic Patients:TIPS or Liver Biopsy = no•Platelets ≤ 30,000•INR ≤ 2.0TIPS or Liver Biopsy = YES•Platelets ≤ 50,000•INR ≤ 2.0 Open table in a new tab