(476) Utility of Thromboelastography During Acute Gastrointestinal Bleeding in Critically Ill Patients

Introduction: Acute gastrointestinal bleeding (GIB) is a common presentation in ICU patients. It can be a life threatening emergency requiring emergent intervention if a bleeding source is not quickly identified. Thromboelastography (TEG) is a non-conventional coagulation test that is infrequently utilized and shows considerable research potential in guiding bleeding management. There has been a paucity of data regarding standardization of TEG. This study will analyze the utility of TEG in ICU patients with acute GIB by comparing TEG guided hemostasis vs. standard testing.

Methods: A retrospective analysis of 100 patients was performed from January- December 2023. Patients were identified using ICD-10 codes K25, K26, K27, K28 and K92.2. EPIC EMR chart review assessed primary and secondary outcome measures.

Results: The primary outcome was blood product utilization for patients with acute GIB with TEG vs standard coagulation testing. 5 patients without standard testing and 15 patients without blood product administration were excluded. Of the remaining 80 patients, 40 had a TEG. Compared to standard testing, those with TEG received a mean of 6 units (U) of RBC’s vs 2.4U RBCs, 1.87U FFP vs 0.1U FFP, 1U platelets vs 0.2U platelets, 0.67U cryoprecipitate vs 0U cryoprecipitate. Secondary outcome measures included length of stay (TEG median 22.1 days vs 13.6 days with standard testing), additional bleeding interventions (12 patients had endoscopic intervention for bleeding from each study arm), and mortality due to GIB (6 patients expired from each study arm).

Conclusions: This study demonstrated that blood product use increased in patients who had TEG during an acute GIB in the ICU. The data selected during a 1 year period may not be reflective of the general population. A potential variable was massive transfusion protocol for 4 patients in the TEG group, which did not occur in the standard testing group. There have been many promising studies using TEG to guide blood product management during cardiac surgery, trauma, and postpartum hemorrhage; however, no data has been presented in patients with acute GIB. While TEG may be a rapid assessment of bleeding parameters, it should not replace standard coagulation testing. More research is needed to further analyze TEG during acute GIB in critically ill patients.