Rapid Update and Revision of: Thromboelastography or Rotational Thromboelastometry Guided Algorithms in Bleeding...

Area of Science:

• Critical Care Medicine
• Transfusion Medicine
• Hematology

Background:

• Bleeding patients face high morbidity and mortality due to impaired hemostasis.
• Optimal hemostatic resuscitation strategies remain unclear.
• Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) offer potential for guiding transfusion therapy.

Purpose of the Study:

• To assess the benefits and risks of TEG/ROTEM-guided transfusion versus standard care in bleeding patients.
• To synthesize evidence from randomized controlled trials (RCTs) in an updated systematic review.
• To evaluate the impact on mortality, blood product administration, blood loss, and reintervention.

Main Methods:

• Systematic review and meta-analysis of RCTs adhering to Cochrane, PRISMA, and GRADE guidelines.
• Comprehensive literature search across five major databases.
• Inclusion of both pediatric and adult patients, with mortality as the primary outcome.

Main Results:

• Included 35 RCTs (n=3096), predominantly in elective cardiac surgery.
• TEG/ROTEM-guided algorithms significantly reduced mortality (RR 0.76) and transfusion of FFP (RR 0.52) and platelets (RR 0.69).
• Significant reductions observed in surgical reintervention (RR 0.63) and bleeding volume (SMD -0.31), with very low certainty of evidence.

Conclusions:

• TEG/ROTEM-guided transfusion may decrease mortality, bleeding, and the need for blood products and reintervention.
• The certainty of evidence for these benefits is very low, primarily based on adult cardiac surgery patients.
• Further high-quality research is necessary to confirm the findings and guide clinical practice.