{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:00:38Z","timestamp":1787868038643,"version":"build-2784847793"},"reference-count":53,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bleeding patients face significant morbidity and mortality due to impaired hemostasis. Hemostatic resuscitation has evolved, yet the optimal approach remains unclear. The primary objective was to assess the benefits and risks of transfusion guided by TEG\/ROTEM versus standard of care in bleeding patients in an updated review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review of randomized controlled trials with meta\u2010analyses and trial sequential analysis was conducted according to Cochrane Collaboration methodology, PRISMA, and GRADE guidelines. A literature search was conducted in five major databases. Both pediatric and adult patients were included. The primary outcome was mortality, and secondary outcomes were the administration of blood products, blood loss, surgical reintervention, and dialysis\u2010dependent renal injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This systematic review included 35 randomized trials (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093096), primarily elective cardiac surgery. TEG\u2010\/ROTEM\u2010guided algorithms led to a statistically significant reduction in mortality (RR\u2009=\u20090.76, 95% CI 0.63\u20130.92)\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      : 0%. Furthermore, a significant reduction in transfused fresh frozen plasma (RR\u2009=\u20090.52, 95% CI 0.35\u20130.76)\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      : 94%, platelets (RR\u2009=\u20090.69, 95% CI 0.55\u20130.87)\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      : 60%, the risk for surgical reintervention (RR\u2009=\u20090.63, 95% CI 0.45\u20130.88)\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      : 0%, and bleeding with a standard mean difference of \u22120.31 (95% CI, \u22120.51 to \u22120.11)\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      : 72% was found.\n                    <\/jats:p>\n                    <jats:p>According to GRADE methodology, the certainty of the evidence was very low for all outcomes. Trial sequential analysis of mortality analysis indicated that 64% of the optimal information size was reached with a crossed alpha\u2010boundary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TEG\u2010\/ROTEM\u2010guided transfusion algorithms may reduce the risk of mortality, bleeding volume, and the need for fresh frozen plasma, platelets, and surgical reintervention, but the evidence is very uncertain. Furthermore, the results were primarily based on the adult population undergoing elective cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>This updated systematic review presents a synthesis of evidence for how thromboelastography or rotational thromboelastometry has been implemented in study conditions to guide tranfusion in bleeding patients. The certainty for the evidence is very limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70127","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T16:44:07Z","timestamp":1758905047000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Rapid Update and Revision of: Thromboelastography or Rotational Thromboelastometry Guided Algorithms in Bleeding Patients\u2014An Updated Systematic Review With Meta\u2010Analysis and Trial Sequential Analysis"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4147-0987","authenticated-orcid":false,"given":"A. D.","family":"Kvisselgaard","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care Copenhagen University Hospital \u2013 Herlev\u2010Gentofte  Copenhagen Denmark"},{"name":"Danish Anaesthesia Allergy Centre, Allergy Clinic 1 Copenhagen University Hospital \u2013 Herlev\u2010Gentofte  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6325-2449","authenticated-orcid":false,"given":"S. A.","family":"Wolthers","sequence":"additional","affiliation":[{"name":"Prehospital Centre Zealand  N\u00e6stved Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6848-8143","authenticated-orcid":false,"given":"A.","family":"Wikkels\u00f8","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine Zealand University Hospital  Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. B.","family":"Holst","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Juliane Marie Center Copenhagen University Hospital \u2010 Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Drivenes","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Afshari","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Juliane Marie Center Copenhagen University Hospital \u2010 Rigshospitalet  Copenhagen Denmark"},{"name":"Institute of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"CD007871","article-title":"Thromboelastography (TEG) or Thromboelastometry (ROTEM) to Monitor Haemostatic Treatment Versus Usual Care in Adults or Children With Bleeding","author":"Wikkels\u00f8 A.","year":"2016","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03018233"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu233"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-018-1217-9"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.02.019"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2018.11.015"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3182054d06"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta19580"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2015.00062"},{"key":"e_1_2_10_11_1","article-title":"Thromboelastography or Rotational Thromboelastometry Guided Algorithms in Bleeding Patients: An Updated Systematic Review With Meta\u2010Analysis and Trial Sequential Analysis","volume":"69","author":"Kvisselgaard A. D.","year":"2025","journal-title":"Acta Anaesthesiologica Scandinavica"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_2_10_15_1","unstructured":"Copenhagen Trial Unit C for CIRR Trial Sequential Analysis Viewer (TSA Viewer)(2016)."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14672"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-019-05939-2"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30794"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15398"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28148"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","unstructured":"A.Tan Rotational Thromboelastometry (ROTEM) Reduces Need for Preemptive Transfusion in Low\u2010Moderate Risk Procedure in Cirrhosis\u2014A Randomized Controlled Trial(2023).","DOI":"10.1016\/S0168-8278(23)00859-0"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.25259\/JCCC_40_2024"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpth.2023.100371"},{"key":"e_1_2_10_24_1","unstructured":"A. A.Perez\u2010Calatayud K.G\u00f6rlinger J.Perez\u2010Uriza et\u00a0al. Patient Blood Management Based Coagulation Management for Massive Postpartum Haemorrhage: A Randomised Controlled Pilot Trial (unpublished data)."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8191.2009.00840.x"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeh037"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.2010.01148.x"},{"key":"e_1_2_10_28_1","first-page":"642","article-title":"Simple Intraoperative Thromboelastography\u2010Guided Transfusion Algorithm Reduces Blood Product Utilization in Cardiac Surgery: A Randomized Controlled Trial","volume":"45","author":"Luk T. H.","year":"2017","journal-title":"Anaesthesia and Intensive Care"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200105000-00014"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/86.4.575"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199902000-00016"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2008.08.016"},{"key":"e_1_2_10_33_1","first-page":"29","article-title":"A Pilot, Randomised Controlled Trial of a Rotational Thromboelastometry\u2010Based Algorithm to Treat Bleeding Episodes in Extracorporeal Life Support: The TEM Protocol in ECLS Study (TEMPEST)","volume":"19","author":"Buscher H.","year":"2017","journal-title":"Critical Care and Resuscitation"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.04.043"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-019-0875-7"},{"key":"e_1_2_10_36_1","first-page":"8","article-title":"A Prospective Randomized Clinical Trial of Efficacy of Algorithm\u2010Based Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart Disease Surgical Patients","volume":"3","author":"Karanjkar A.","year":"2019","journal-title":"Journal of Cardiac Critical Care TSS"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288-020-01375-9"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-020-02810-x"},{"key":"e_1_2_10_39_1","first-page":"154","article-title":"A\u00e7ik Kalp Cerrahisinde Tromboelastografinin Transf\u00fcZyon Karari \u00dcZerine Etkisi","volume":"12","author":"Kultufan Turan S.","year":"2006","journal-title":"Gogus\u2010Kalp\u2010Damar Anestezi Ve Yogun Bakim Dernegi Dergisi"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-019-0689-7"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu339"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003643-201106001-00301"},{"key":"e_1_2_10_43_1","first-page":"40","article-title":"Reduced Number of Red Blood Cell Transfusions in Cardiac Surgery due to Perioperative Coagulation Testing by Thromboelastometry","volume":"51","author":"Rauter M.","year":"2007","journal-title":"Acta Anaesthesiologica Scandinavica"},{"key":"e_1_2_10_44_1","doi-asserted-by":"crossref","unstructured":"C. F.Weber K.G\u00f6 D.Meininger et\u00a0al. Point\u2010of\u2010Care Testing A Prospective Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients(2012).","DOI":"10.1097\/ALN.0b013e318264c644"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000001084"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2010.05.144"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06266-1"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001608"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.10.031"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2022.102470"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.916017"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001214"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-023-02372-0"},{"key":"e_1_2_10_54_1","first-page":"137","article-title":"Efficacy of Thromboelastography to Monitor the Clinical Massive Transfusion in Scoliosis: A Randomized Controlled Trial","volume":"54","author":"Cao X.","year":"2016","journal-title":"Chinese Journal of Surgery"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.70127","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T16:32:45Z","timestamp":1763051565000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.70127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":53,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/aas.70127"],"URL":"https:\/\/doi.org\/10.1111\/aas.70127","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]},"assertion":[{"value":"2025-06-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70127"}}