{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T18:47:07Z","timestamp":1788115627812,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002076","name":"Emergency Medicine Foundation","doi-asserted-by":"publisher","award":["233R38\u20102022\u2010LATONA"],"award-info":[{"award-number":["233R38\u20102022\u2010LATONA"]}],"id":[{"id":"10.13039\/100002076","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion Medicine"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Viscoelastic haemostatic assays (VHA) are part of patient blood management (PBM) for bleeding, associated with reduced transfusions. This study reviewed all major haemorrhage protocols (MHPs) using VHA in Queensland, Australia, and assessed variability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>VHA platforms in Queensland Health include rotational thromboelastometry (ROTEM\u00ae Sigma) and thromboelastography (TEG 6\u2009s). PBM guidelines were searched for VHA\u2010guided MHPs. Outcomes included viscoelastic thresholds and transfusion recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen hospitals used VHA: sixteen with ROTEM and three with TEG. Among hospitals with ROTEM, fibrinolysis was assessed first in 13 algorithms, primarily using FIBTEM flat\u2010line (<jats:italic>n<\/jats:italic>\u2009=\u20096) or ML &gt;5% (<jats:italic>n<\/jats:italic>\u2009=\u20095). Fibrinogen thresholds were FIBTEM A5 &lt;10\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u200915) and &lt;12\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20091). Platelet thresholds included EXTEM A5 &lt;25\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20092) or EXTEM A5 &lt;35\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20096) as isolated criteria, and EXTEM A5 &lt;35\u2009mm combined with FIBTEM A5 &gt;10\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20099) as combined criterion. Coagulation factor thresholds were EXTEM CT &gt;90\u2009s (<jats:italic>n<\/jats:italic>\u2009=\u200913), EXTEM CT &gt;80\u2009s (<jats:italic>n<\/jats:italic>\u2009=\u20092) and INTEM CT \u2265240\u2009s (<jats:italic>n<\/jats:italic>\u2009=\u20091).<\/jats:p><jats:p>TEG algorithms used CFF MA\/A10 &lt;15\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20093), &lt;10\u2009mm and\u2009&lt;5\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20091). Platelet thresholds: CRT MA &lt;50\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20093), and &lt;25\u2009mm (<jats:italic>n<\/jats:italic>\u2009=\u20091). Coagulation factor thresholds: CK R &gt;9\u2009min (<jats:italic>n<\/jats:italic>\u2009=\u20092) and CKH R &gt;10\u2009min (<jats:italic>n<\/jats:italic>\u2009=\u20091). Fibrinolysis: CRT LY30 &gt;2.2% (<jats:italic>n<\/jats:italic>\u2009=\u20093). Doses varied across all algorithms: cryoprecipitate (10\u201330\u2009U), FC (3\u20136\u2009g), platelet (1\u20132\u2009U), fresh frozen plasma (1\u20134\u2009U), and prothrombin complex concentrate (PCC) (5\u201350\u2009U\/kg).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>VHA\u2010guided MHP showed marked variation with inconsistent transfusion thresholds. For similar clot kinetics, dosing of blood products and haemostatic agents differed, particularly PCC. Patients with the same coagulopathy may receive different treatment across hospitals. Centralised standardisation could improve PBM consistency.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tme.70003","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T05:19:12Z","timestamp":1753334352000},"page":"476-485","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Variability in viscoelastic haemostatic assay in major haemorrhage protocols: A unified approach or mixed signals?"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4275-2588","authenticated-orcid":false,"given":"Akmez","family":"Latona","sequence":"first","affiliation":[{"name":"Emergency Department Ipswich Hospital  Ipswich Queensland Australia"},{"name":"Statewide Anticoagulation Committee Queensland Health  Brisbane Queensland Australia"},{"name":"LifeFlight Retrieval Medicine  Toowoomba Queensland Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"The University of Queensland Faculty of Medicine  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Winearls","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"The University of Queensland Faculty of Medicine  Brisbane Queensland Australia"},{"name":"Intensive Care Unit Gold Coast University Hospital  God Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Hill","sequence":"additional","affiliation":[{"name":"Statewide Anticoagulation Committee Queensland Health  Brisbane Queensland Australia"},{"name":"Department of Haematology Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"Central Laboratory Pathology Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1498-7822","authenticated-orcid":false,"given":"Michelle","family":"Spanevello","sequence":"additional","affiliation":[{"name":"Statewide Anticoagulation Committee Queensland Health  Brisbane Queensland Australia"},{"name":"Department of Haematology Royal Brisbane and Women's Hospital  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-2450","authenticated-orcid":false,"given":"Biswadev","family":"Mitra","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"1 Expeditionary Health Squadron Royal Australian Air Force  Amberley Queensland Australia"},{"name":"Emergency &amp; Trauma Centre The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13123612"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.4097\/kja.19169"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11030860"},{"issue":"1","key":"e_1_2_12_5_1","first-page":"v","article-title":"Viscoelastic point\u2010of\u2010care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost\u2010effectiveness analysis","volume":"19","author":"Whiting P","year":"2015","journal-title":"Health Technol Assess"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2022.03.001"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2016.04.008"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40140-024-00637-w"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52212"},{"key":"e_1_2_12_10_1","first-page":"423","article-title":"How well does your massive transfusion protocol perform? A scoping review of quality indicators","volume":"18","author":"Sanderson B","year":"2020","journal-title":"Blood Transfus"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v12.i11.1115"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-022-00454-8"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04327-7"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06266-1"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18275"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001997"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002825"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003643-200606001-00302"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2023.07.009"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000333"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2014.11.032"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000657"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.51893\/2021.1.OA3"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2015.07.003"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex122"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-30726-8_29"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2008.11.008"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13459"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000446304"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-309922"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30197-7"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer158"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52538"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.14058"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.4080"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc8948"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-015-0165-4"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14991"}],"container-title":["Transfusion Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tme.70003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T23:40:17Z","timestamp":1759794017000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tme.70003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/tme.70003"],"URL":"https:\/\/doi.org\/10.1111\/tme.70003","archive":["Portico"],"relation":{},"ISSN":["0958-7578","1365-3148"],"issn-type":[{"value":"0958-7578","type":"print"},{"value":"1365-3148","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,23]]},"assertion":[{"value":"2025-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}