# Critical trigger thresholds for hemostatic management: a narrative review of viscoelastic hemostatic assay applications

## TL;DR

This review discusses how viscoelastic hemostatic assays can guide blood management in surgeries with high bleeding risks, offering benefits over traditional tests.

## Contribution

The paper provides a narrative review of trigger thresholds and algorithms for using viscoelastic hemostatic assays in surgical hemostatic management.

## Key findings

- VHA can reduce bleeding volume and allogeneic blood product use in high-risk surgeries.
- VHA improves patient outcomes and cost-effectiveness compared to traditional coagulation tests.
- Clear guidelines for VHA use in surgical patients remain undefined despite their widespread adoption.

## Abstract

Viscoelastic haemostasis assays (VHA) are increasingly used in clinical practice. These bedside whole-blood tests, commonly implemented through thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are prized for their speed, accuracy, and accessibility, resulting in their increased usage in managing complex cases such as severe trauma, cardiac surgery, postpartum hemorrhage, and liver disease. Despite their widespread use, clear guidelines for regulating coagulation function in surgical patients through VHA remain undefined. This review searched the majority of the literature on VHA in the past decade and discussed the triggers and algorithms for hemostatic management guided by VHA in surgeries with a high risk of major bleeding. It also reviews the potential benefits of VHA over traditional coagulation tests (like prothrombin time and partial thromboplastin time) and clinical judgments, focusing on aspects such as reducing bleeding volume, decreasing use of allogeneic blood products, improving patient outcomes and mortality, and enhancing cost-effectiveness.