title: The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products - A systematic review and meta-analysis.
abstract: BACKGROUND
  Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality.
  
  
  METHODS
  PubMed and EMBASE were searched for RCTs that 1) randomised patients into receiving transfusions based on either a VHA-guided (thromboelastography [TEG] or rotational thromboelastometry [ROTEM]) algorithm (intervention group) or at the clinician's discretion and/or based on conventional coagulation tests (control group) and 2) adequately reported on the outcomes bleeding and/or transfusions and/or mortality. Data on bleeding, transfusions and mortality were extracted from each trial and included in a meta-analysis.
  
  
  RESULTS
  Fifteen RCTs (n = 1238 patients) were included. Nine trials referred to cardiothoracic patients, one to liver transplantation, one to surgical excision of burn wounds and one to trauma. One trial was conducted with cirrhotic patients, one with patients undergoing scoliosis surgery while one trial randomised treatment in post-partum females presenting with bleeding. The amount of transfused red blood cells (RBCs), fresh frozen plasma (FFP) and bleeding volume was found to be significantly reduced in the VHA-guided groups, whereas no significant difference was found for platelet transfusion requirements or mortality.
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. mathilde.fahrendorff@regionh.dk.
authors.forename: Mathilde
authors.identifier: http://orcid.org/0000-0002-7646-4894
authors.initials: M
authors.lastname: Fahrendorff
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Oliveri
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.|Department of Surgery, Centre for Translational Injury Research, UT Health, University of Texas Health Science Center at Houston, Houston, TX, USA.|Center for Systems Biology. The School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D001803:Blood Transfusion / Q000379:methods*; D017707:Erythrocyte Transfusion; D006470:Hemorrhage / Q000097:blood* / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D010949:Plasma; D017713:Platelet Transfusion; D016032:Randomized Controlled Trials as Topic; D013916:Thrombelastography
keywords: Bleeding; Mortality; ROTEM; TEG; Thrombelastography; Thrombelastometry