What would be your transfusion strategy for a patient with decompensated cirrhosis presenting with concomitant acute upper GI bleed and acute MI?

I would be guided by the patient's vital signs, response to crystalloids, and clinical findings for red cell transfusion decisions, more so than any hemoglobin/hematocrit determination. I would avoid plasma transfusion for INR/prothrombin time abnormalities unless the viscoelastic testing demonstrated a coagulation factor deficit (e.g., R time for TEG). Transfusions are only methods of buying time while the proceduralists or surgeon address the underlying problems.

Some would aggressively transfuse red cells based upon the MINT trial in acute MI, but I think that would be suboptimal. The MINT trial has flaws and indeed did not achieve conventional metrics of statistical significance. Despite this, and a large negative European trial of liber...