Viscoelastic haemostatic assays to guide therapy in elective surgery: an updated systematic review and meta‐analysis

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Abstract
Summary: Background: Patients undergoing major surgery frequently experience major uncontrolled bleeding. The aim of this systematic review and meta‐analysis was to evaluate the clinical efficacy of using viscoelastic haemostatic assays to manage peri‐operative bleeding in elective surgery. Methods: We searched PubMed/MEDLINE and Embase databases for randomised controlled trials according to pre‐determined criteria. The primary outcomes were blood product requirements; duration of stay in the operating theatre or ICU; and surgical reintervention rate. Results: We included 20 randomised controlled trials. The overall risk of bias was low to moderate. Twelve studies used thromboelastography‐based transfusion algorithms, while eight used thromboelastometry. Viscoelastic haemostatic assay‐guided therapy was associated with a statistically significant reduction in transfusion of red blood cells (standardised mean difference (95%CI) 0.16 (‐0.29 to 0.02)), platelets (standardised mean difference (95%CI) ‐0.33 (‐0.56 to ‐0.10)) and fresh frozen plasma (standardised mean difference (95%CI) ‐0.64 (‐1.01 to ‐0.28)). There was no evidence of an effect of viscoelastic haemostatic assay‐guided therapy on surgical reintervention (relative risk (95%CI) 1.09 (0.70–1.69)). Viscoelastic haemostatic assay‐guided therapy was associated with lower blood loss and shorter ICU duration of stay. There was no evidence of any effect on total duration of stay and all‐cause mortality. Conclusions: Viscoelastic haemostatic assay‐guided therapy may reduce peri‐operative blood product transfusion requirements and blood loss during major elective surgery, with no discernible effect on patient‐centred outcomes. The overall quality of evidence was modest.
Funding Information
  • Haemonetics Corporation

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