{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:01:53Z","timestamp":1790211713482,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vox Sanguinis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Effective transfusion management is essential in trauma patients with active bleeding. In this study, we aimed to evaluate the association between point\u2010of\u2010care rotational thromboelastometry (ROTEM)\u2010guided management, blood\u2010component utilization, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective comparative cohort study of 200 trauma patients with active bleeding admitted between October 2023 and March 2025. One\u2010hundred patients received ROTEM\u2010guided management and 100 were managed using conventional coagulation tests. Blood\u2010component utilization during the first 24\u2009h and clinical outcomes were analyzed using multivariable models adjusted for relevant baseline variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ROTEM\u2010guided management was associated with lower fresh frozen plasma utilization (adjusted incidence rate ratio [aIRR] 0.36, 95% confidence interval [CI]: 0.24\u20130.55), higher cryoprecipitate utilization (aIRR 1.92, 95% CI: 1.40\u20132.66), and shorter intensive care unit (ICU) stay. Adjusted red blood cell (RBC) and platelet utilization did not differ between groups. Maximum clot firmness in the fibrin\u2010based thromboelastometry assay\u00a0correlated strongly with fibrinogen concentration, and clot formation time in the extrinsically activated thromboelastometry assay correlated inversely with platelet count. Differences in transfusion\u2010related complications and in\u2010hospital mortality were not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ROTEM\u2010guided management was associated with lower plasma utilization, higher cryoprecipitate utilization, and shorter ICU stay. Given the retrospective, non\u2010randomized design and low RBC exposure, these findings should not be interpreted as evidence that ROTEM reduced bleeding severity or RBC requirements, particularly in massive\u2010transfusion populations. Prospective studies in trauma patients with massive hemorrhage are required to evaluate the utility of ROTEM in guiding specific hemostatic blood\u2010product transfusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/vox.70378","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:19:42Z","timestamp":1790209182000},"source":"Crossref","is-referenced-by-count":0,"title":["<scp>Rotational thromboelastometry\u2010guided<\/scp>\n                    transfusion in acute trauma: Less plasma, greater precision"],"prefix":"10.1111","author":[{"given":"Radovan","family":"Dini\u0107","sequence":"first","affiliation":[{"name":"Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almira","family":"\u0160abani","sequence":"additional","affiliation":[{"name":"Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biljana","family":"\u017divoti\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Horvacki","sequence":"additional","affiliation":[{"name":"Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nenad","family":"Mladenovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Transfusion Medicine and Blood Bank, Emergency Center University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3092-4768","authenticated-orcid":false,"given":"Jasmina","family":"Gruji\u0107","sequence":"additional","affiliation":[{"name":"Department of Transfusiology, Faculty of Medicine University of Novi Sad  Novi Sad Serbia"},{"name":"Department of Laboratory Diagnostics Blood Transfusion Institute of Vojvodina  Novi Sad Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Injuries and violence: the facts 2021","author":"World Health Organization","year":"2021"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s13017-022-00454-8","article-title":"Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review","volume":"17","author":"Zhu Z","year":"2022","journal-title":"World J Emerg Surg"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics15091148","article-title":"Clinical significance of rotational thromboelastometry (ROTEM) for detection of early coagulopathy in trauma patients: a retrospective study","volume":"15","author":"Asim M","year":"2025","journal-title":"Diagnostics"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13049-024-01196-z","article-title":"Characteristics of traumatic major haemorrhage in a tertiary trauma center","volume":"32","author":"Wyk P","year":"2024","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.3390\/medicines8040016","article-title":"Trauma\u2010induced coagulopathy: overview of an emerging medical problem from pathophysiology to outcomes","volume":"8","author":"Savioli G","year":"2021","journal-title":"Medicines"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"3969","DOI":"10.1007\/s00068-022-01916-z","article-title":"Physiology dictated treatment after severe trauma: timing is everything","volume":"48","author":"Wessem KJP","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/1742-6723.13643","article-title":"Implementation of point\u2010of\u2010care ROTEM\u00ae into a trauma major haemorrhage protocol: a before and after study","volume":"33","author":"Campbell D","year":"2021","journal-title":"Emerg Med Australas"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1055\/s-0037-1598057","article-title":"Viscoelastic testing in trauma","volume":"43","author":"Wirtz MR","year":"2017","journal-title":"Semin Thromb Hemost"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"130","DOI":"10.4103\/ajts.ajts_18_23","article-title":"Rotational thromboelastometry and patient blood management: a narrative review","volume":"19","author":"Khalaf\u2010Adeli E","year":"2025","journal-title":"Asian J Transfus Sci"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13054-023-04421-w","article-title":"Thromboelastometry\u2010guided haemostatic resuscitation in severely injured patients: a propensity score\u2010matched study","volume":"27","author":"David JS","year":"2023","journal-title":"Crit Care"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2025.1658845","article-title":"Critical trigger thresholds for hemostatic management: a narrative review of viscoelastic hemostatic assay applications","volume":"12","author":"Xu ZL","year":"2025","journal-title":"Front Med"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13741-025-00562-4","article-title":"The influence of rotational thromboelastometry (ROTEM) on operating room and intensive care transfusion practices in major trauma bleeding: a prospective cohort study","volume":"14","author":"Kozera N","year":"2025","journal-title":"Perioper Med"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"7564","DOI":"10.1182\/blood-2024-208152","article-title":"Enhancing compliance to massive hemorrhage protocol through clinical decision support tool for thromboelastography interpretation","volume":"144","author":"Imhoff S","year":"2024","journal-title":"Blood"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1757-7241-20-15","article-title":"Early and individualized goal\u2010directed therapy for trauma\u2010induced coagulopathy","volume":"20","author":"Sch\u00f6chl H","year":"2012","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/tme.13018","article-title":"Utility of rotational thromboelastometry in the management of massive haemorrhage at a regional Australian hospital","volume":"34","author":"Liu YH","year":"2024","journal-title":"Transfus Med"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jfma.2025.07.016","article-title":"Current controversies and advances in massive transfusion: balancing evidence and practice","volume":"125","author":"Lin TL","year":"2026","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jemermed.2020.04.009","article-title":"Tracing the lines: a review of viscoelastography for emergency medicine clinicians","volume":"59","author":"Gilbert BW","year":"2020","journal-title":"J Emerg Med"},{"key":"e_1_2_9_19_1","article-title":"Correlation between maximum clot firmness in FIBTEM and fibrinogen level in critical trauma patients","volume":"2019","author":"Khunakanan S","year":"2019","journal-title":"Crit Care Res Pract"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.mporth.2021.02.001","article-title":"The use of viscoelastic tests in driving transfusion needs in major trauma patients","volume":"35","author":"Pickard A","year":"2021","journal-title":"Orthop Trauma"},{"key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1182\/asheducation-2018.1.585","article-title":"TACO and TRALI: biology, risk factors, and prevention strategies","volume":"2018","author":"Roubinian N","year":"2018","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1097\/SLA.0000000000001608","article-title":"Goal\u2010directed hemostatic resuscitation of trauma\u2010induced coagulopathy: a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays","volume":"263","author":"Gonzalez E","year":"2016","journal-title":"Ann Surg"},{"key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1007\/s00134-024-07437-0","article-title":"Visco\u2010elastic testing in traumatic bleeding","volume":"50","author":"Juffermans NP","year":"2024","journal-title":"Intensive Care Med"},{"key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/00031348241309563","article-title":"What, when, and why: viscoelastic hemostatic assays and their uses in trauma resuscitation","volume":"91","author":"Burkhart JG","year":"2025","journal-title":"Am Surg"}],"container-title":["Vox 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