Rotational Thromboelastometry (ROTEM™) Guided Transfusion for Elective Procedures in Patients With Cirrhosis (REduCe): An Open Label Randomized Controlled Trial.

Inclusion Criteria

• •Patients with Cirrhosis undergoing elective procedure must meet all following criterias.
• •1. Patients undergoing the following elective procedures will be included in the study
• •1. Gastroscopy with endoscopic variceal ligation
• •2. Colonoscopy with polypectomy and endoscopic mucosal resection
• •3. ERCP with sphincterotomy
• •4. Percutaneous liver biopsy
• •5. Biopsy of other sites (excluding liver)
• •6. Hepatic venous pressure gradient with or without liver biopsy
• •7. Elective Transjugular Intrahepatic Portosystemic Shunt
• •8. Portal Vein embolization
• •9. Trans-arterial chemo-embolization (TACE)
• •10. Thermal ablation of hepatocellular carcinoma
• •11. Large volume paracentesis
• •12. Central venous catheter insertion
• •13. Thoracentesis
• •2. Age: Older than 21 years
• •3. Coagulopathy based on conventional coagulation tests which is defined as
• •1. INR \> 1.5 and/or aPTT \> 1.5x ULN for PTT and/or
• •2. Platelets \< 50,000/mm3/uL
• •4. Patients with acute decompensation, acute on chronic liver failure and acute liver failure.
• •5. Able to give informed consent.