{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:06:49Z","timestamp":1789175209039,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Bleeding risk in cirrhotic patients undergoing invasive procedures is traditionally assessed using conventional coagulation tests, which poorly reflect the rebalanced haemostatic state of cirrhosis and often lead to unnecessary transfusions. Viscoelastic testing (VET) provides a global assessment of coagulation and may enable more rational transfusion strategies. We performed a systematic review and meta\u2010analysis of randomised controlled trials (RCTs) to evaluate the efficacy and safety of VET\u2010guided transfusion strategies in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Embase and Scopus from inception to 10 April 2026. RCTs comparing VET\u2010guided versus standard\u2010of\u2010care transfusion strategies in cirrhotic patients undergoing invasive procedures were included. Primary outcome was procedure\u2010related bleeding; secondary outcomes included transfusion requirements. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using the Mantel\u2013Haenszel method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six RCTs including 296 patients were analysed. Procedure\u2010related bleeding was rare and did not differ between groups (RR 0.74, 95% CI 0.24\u20132.31;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). In contrast, VET\u2010guided strategies significantly reduced transfusion requirements, including any blood product transfusion (RR 0.33, 95% CI 0.26\u20130.44;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200956%), platelet transfusion (RR 0.20, 95% CI 0.13\u20130.32;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200940%), any fresh frozen plasma (FFP) exposure (RR 0.40, 95% CI 0.28\u20130.57;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200963%) and FFP\u2010only transfusion (RR 0.22, 95% CI 0.10\u20130.46;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200981%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>VET\u2010guided transfusion strategies significantly reduce blood product utilisation without increasing bleeding risk in cirrhotic patients undergoing invasive procedures. These findings support a shift towards a physiology\u2010based approach to haemostasis, with potential benefits for patient safety and resource optimisation.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      ClinicalTrials.gov identifier: CRD420261382437.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70782","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:41:38Z","timestamp":1783485698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Viscoelastic Tests in Cirrhotic Patients Undergoing Invasive Procedures: A Systematic Review and Meta\u2010Analysis of RCTs"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-7790","authenticated-orcid":false,"given":"Andrea","family":"Boccatonda","sequence":"first","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Campello","sequence":"additional","affiliation":[{"name":"First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine Padova University Hospital  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Napolitano","sequence":"additional","affiliation":[{"name":"First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine Padova University Hospital  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Bray","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Simion","sequence":"additional","affiliation":[{"name":"First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine Padova University Hospital  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Serra","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8264-1845","authenticated-orcid":false,"given":"Fabio","family":"Piscaglia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"},{"name":"Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4339-8525","authenticated-orcid":false,"given":"Luca","family":"Spiezia","sequence":"additional","affiliation":[{"name":"First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine Padova University Hospital  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Simioni","sequence":"additional","affiliation":[{"name":"First Chair of Internal Medicine, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine Padova University Hospital  Padova 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