{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T02:45:17Z","timestamp":1789872317622,"version":"4.0.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVE:<\/jats:title>\n                    <jats:p>We compared the overall clinical outcome in formula-based protocol (1:1:1) and thromboelastogram (TEG)-guided goal-based massive transfusion (MT) in the resuscitation of patients with hemorrhagic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>This was a retro-prospective case\u2013control study conducted over a period of 2 years among the patients who received MT using a 1:1:1 fixed ratio protocol (controls, Group A) and goal-based protocol (cases, Group B) guided through TEG. Patients were matched for the type and severity of the clinical conditions. Utilization of blood components, clinical outcomes, transfusion-related complications, and total mortality rates were compared between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      There were 113 patients in the formula-based group and 109 patients in the goal-based transfusion group who were matched for injury severity scores. The total blood components utilized were 1867 and 1560, respectively, with a 17.7% reduction associated with the use of TEG. Patients were divided into normal, hypo, and hypercoagulable based on TEG, and a higher transfusion rate was associated with hypocoagulable TEG (942 vs. 610). The prothrombin time, activated partial thromboplastin time, R time, and K time had a significant positive correlation with the need to transfuse more than 20 blood components, whereas platelet count, base excess, alpha angle, MA, and CI had a negative correlation (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.268,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). At the end of goal-directed transfusion, 75% of the patients were free of transfusion support (vs. 65.4%) and only 6.9% of the patients had coagulopathy (vs. 31.8%) compared to formula-based resuscitation with a 10% reduction in mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>TEG-guided goal-based approach helped to reduce blood component utilization with a reduced incidence of coagulopathy at the end of the MT while improving patient survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ajts.ajts_56_23","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T06:07:53Z","timestamp":1719209273000},"page":"7-15","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Tailoring transfusion strategy using thromboelastogram in goal-directed massive transfusion: Impact on transfusion requirements and clinical outcomes"],"prefix":"10.4103","volume":"18","author":[{"given":"P. A.","family":"Prethika","sequence":"first","affiliation":[{"name":"Department of Immunohematology and Blood Transfusion, Apollo Hospitals, Chennai, Tamil Nadu, India"},{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamee","family":"Shastry","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaraj Mymbilly","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"R1-20240830","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/2013.jamasurg.387","article-title":"The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study:Comparative effectiveness of a time-varying treatment with competing risks","volume":"148","author":"Holcomb","year":"2013","journal-title":"JAMA Surg"},{"key":"R2-20240830","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/bjaceaccp\/mku049","article-title":"Major obstetric haemorrhage","volume":"15","author":"Plat","year":"2015","journal-title":"BJA Educ"},{"key":"R3-20240830","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.tmrv.2017.06.003","article-title":"Optimal dose, timing and ratio of blood products in massive transfusion:Results from a systematic review","volume":"32","author":"McQuilten","year":"2018","journal-title":"Transfus Med Rev"},{"key":"R4-20240830","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1213\/ANE.0000000000001926","article-title":"Massive transfusion in cardiac surgery:The impact of blood component ratios on clinical outcomes and survival","volume":"124","author":"Delaney","year":"2017","journal-title":"Anesth Analg"},{"key":"R5-20240830","doi-asserted-by":"crossref","first-page":"4793","DOI":"10.3390\/jcm10204793","article-title":"The pathophysiology and management of hemorrhagic shock in the polytrauma patient","volume":"10","author":"Fecher","year":"2021","journal-title":"J Clin Med"},{"key":"R6-20240830","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1055\/s-0030-1265289","article-title":"Coagulation abnormalities in the trauma patient:The role of point-of-care thromboelastography","volume":"36","author":"Gonzalez","year":"2010","journal-title":"Semin Thromb Hemost"},{"key":"R7-20240830","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1097\/SLA.0000000000001608","article-title":"Goal-directed hemostatic resuscitation of trauma-induced coagulopathy:A pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays","volume":"263","author":"Gonzalez","year":"2016","journal-title":"Ann Surg"},{"key":"R8-20240830","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1213\/ANE.0b013e318270a6f7","article-title":"Trauma bleeding management:The concept of goal-directed primary care","volume":"119","author":"Sch\u00f6chl","year":"2014","journal-title":"Anesth Analg"},{"key":"R9-20240830","doi-asserted-by":"crossref","first-page":"R55","DOI":"10.1186\/cc8948","article-title":"Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate","volume":"14","author":"Sch\u00f6chl","year":"2010","journal-title":"Crit Care"},{"key":"R10-20240830","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13049-017-0378-9","article-title":"The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products \u2013A systematic review and meta-analysis","volume":"25","author":"Fahrendorff","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R11-20240830","doi-asserted-by":"crossref","first-page":"3052","DOI":"10.1182\/blood-2014-05-575340","article-title":"How I treat patients with massive hemorrhage","volume":"124","author":"Johansson","year":"2014","journal-title":"Blood"},{"key":"R12-20240830","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13049-017-0443-4","article-title":"The impact of early thromboelastography directed therapy in trauma resuscitation","volume":"25","author":"Mohamed","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R13-20240830","first-page":"e12552","article-title":"Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding","volume":"22","author":"Wikkels\u00f8","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"R14-20240830","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1182\/blood-2014-10-512608","article-title":"How I treat postpartum hemorrhage","volume":"125","author":"Pavord","year":"2015","journal-title":"Blood"},{"key":"R15-20240830","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1182\/blood-2014-04-567891","article-title":"Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage:A prospective study","volume":"124","author":"Collins","year":"2014","journal-title":"Blood"},{"key":"R16-20240830","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijoa.2013.01.002","article-title":"Postpartum hemorrhage and low fibrinogen levels:The past, present and future","volume":"22","author":"Butwick","year":"2013","journal-title":"Int J Obstet Anesth"},{"key":"R17-20240830","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/bja\/aev033","article-title":"Fibrinogen concentrates for post-partum haemorrhage?Do not miss the most relevant population!","volume":"114","author":"Ickx","year":"2015","journal-title":"Br J Anaesth"},{"key":"R18-20240830","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","article-title":"Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN):An international, randomised, double-blind, placebo-controlled trial","volume":"389","author":"Shakur","year":"2017","journal-title":"Lancet"},{"key":"R19-20240830","first-page":"e106","article-title":"Prevention and management of postpartum haemorrhage \u2013On behalf of royal college of obstetricians and gynaecologists","volume":"124","author":"Marvides","year":"2016","journal-title":"BJOG"},{"key":"R20-20240830","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1111\/jth.12190","article-title":"Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT\/ACOTS)","volume":"11","author":"Gando","year":"2013","journal-title":"J Thromb Haemost"},{"key":"R21-20240830","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/ijlh.12688","article-title":"Global assays of fibrinolysis","volume":"39","author":"Ilich","year":"2017","journal-title":"Int J Lab Hematol"},{"key":"R22-20240830","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1055\/s-0039-1701018","article-title":"Traumatic-induced coagulopathy as a systems failure:A new window into hemostasis","volume":"46","author":"Dobson","year":"2020","journal-title":"Semin Thromb Hemost"},{"key":"R23-20240830","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/MOH.0000000000000063","article-title":"Mechanisms of trauma-induced coagulopathy","volume":"21","author":"Cardenas","year":"2014","journal-title":"Curr Opin Hematol"},{"key":"R24-20240830","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1055\/s-0040-1702202","article-title":"The complexity of trauma-induced coagulopathy","volume":"46","author":"Moore","year":"2020","journal-title":"Semin Thromb Hemost"},{"key":"R25-20240830","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.tmrv.2021.07.004","article-title":"Pathophysiology of trauma-induced coagulopathy","volume":"35","author":"Duque","year":"2021","journal-title":"Transfus Med Rev"},{"issue":"Suppl 1","key":"R26-20240830","doi-asserted-by":"crossref","first-page":"i71","DOI":"10.1093\/bja\/aet376","article-title":"Update on massive transfusion","volume":"111","author":"Pham","year":"2013","journal-title":"Br J Anaesth"},{"key":"R27-20240830","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/jth.14378","article-title":"Towards patient-specific management of trauma hemorrhage:The effect of resuscitation therapy on parameters of thromboelastometry","volume":"17","author":"Juffermans","year":"2019","journal-title":"J Thromb Haemost"},{"key":"R28-20240830","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1186\/s13054-014-0637-3","article-title":"TEG\u00ae- or ROTEM\u00ae-based individualized goal-directed coagulation algorithms:Don't wait \u2013Act now!","volume":"18","author":"Spahn","year":"2014","journal-title":"Crit Care"}],"container-title":["Asian Journal of Transfusion Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ajts.ajts_56_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:39:16Z","timestamp":1787067556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ajts.ajts_56_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ajts.ajts_56_23","relation":{},"ISSN":["0973-6247","1998-3565"],"issn-type":[{"value":"0973-6247","type":"print"},{"value":"1998-3565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-03-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}