Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Aug 22;2016(8):CD007871.
doi: 10.1002/14651858.CD007871.pub3.

Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding

Anne Wikkelsø  1 , Jørn Wetterslev, Ann Merete Møller, Arash Afshari
Affiliations
Meta-Analysis

Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding

Anne Wikkelsø et al. Cochrane Database Syst Rev. .

Abstract

Background: Severe bleeding and coagulopathy are serious clinical conditions that are associated with high mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are increasingly used to guide transfusion strategy but their roles remain disputed. This review was first published in 2011 and updated in January 2016.

Objectives: We assessed the benefits and harms of thromboelastography (TEG)-guided or thromboelastometry (ROTEM)-guided transfusion in adults and children with bleeding. We looked at various outcomes, such as overall mortality and bleeding events, conducted subgroup and sensitivity analyses, examined the role of bias, and applied trial sequential analyses (TSAs) to examine the amount of evidence gathered so far.

Search methods: In this updated review we identified randomized controlled trials (RCTs) from the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1); MEDLINE; Embase; Science Citation Index Expanded; International Web of Science; CINAHL; LILACS; and the Chinese Biomedical Literature Database (up to 5 January 2016). We contacted trial authors, authors of previous reviews, and manufacturers in the field. The original search was run in October 2010.

Selection criteria: We included all RCTs, irrespective of blinding or language, that compared transfusion guided by TEG or ROTEM to transfusion guided by clinical judgement, guided by standard laboratory tests, or a combination. We also included interventional algorithms including both TEG or ROTEM in combination with standard laboratory tests or other devices. The primary analysis included trials on TEG or ROTEM versus any comparator.

Data collection and analysis: Two review authors independently abstracted data; we resolved any disagreements by discussion. We presented pooled estimates of the intervention effects on dichotomous outcomes as risk ratio (RR) with 95% confidence intervals (CIs). Due to skewed data, meta-analysis was not provided for continuous outcome data. Our primary outcome measure was all-cause mortality. We performed subgroup and sensitivity analyses to assess the effect based on the presence of coagulopathy of a TEG- or ROTEM-guided algorithm, and in adults and children on various clinical and physiological outcomes. We assessed the risk of bias through assessment of trial methodological components and the risk of random error through TSA.

Main results: We included eight new studies (617 participants) in this updated review. In total we included 17 studies (1493 participants). A total of 15 trials provided data for the meta-analyses. We judged only two trials as low risk of bias. The majority of studies included participants undergoing cardiac surgery.We found six ongoing trials but were unable to retrieve any data from them. Compared with transfusion guided by any method, TEG or ROTEM seemed to reduce overall mortality (7.4% versus 3.9%; risk ratio (RR) 0.52, 95% CI 0.28 to 0.95; I(2) = 0%, 8 studies, 717 participants, low quality of evidence) but only eight trials provided data on mortality, and two were zero event trials. Our analyses demonstrated a statistically significant effect of TEG or ROTEM compared to any comparison on the proportion of participants transfused with pooled red blood cells (PRBCs) (RR 0.86, 95% CI 0.79 to 0.94; I(2) = 0%, 10 studies, 832 participants, low quality of evidence), fresh frozen plasma (FFP) (RR 0.57, 95% CI 0.33 to 0.96; I(2) = 86%, 8 studies, 761 participants, low quality of evidence), platelets (RR 0.73, 95% CI 0.60 to 0.88; I(2) = 0%, 10 studies, 832 participants, low quality of evidence), and overall haemostatic transfusion with FFP or platelets (low quality of evidence). Meta-analyses also showed fewer participants with dialysis-dependent renal failure.We found no difference in the proportion needing surgical reinterventions (RR 0.75, 95% CI 0.50 to 1.10; I(2) = 0%, 9 studies, 887 participants, low quality of evidence) and excessive bleeding events or massive transfusion (RR 0.38, 95% CI 0.38 to 1.77; I(2) = 34%, 2 studies, 280 participants, low quality of evidence). The planned subgroup analyses failed to show any significant differences.We graded the quality of evidence as low based on the high risk of bias in the studies, large heterogeneity, low number of events, imprecision, and indirectness. TSA indicates that only 54% of required information size has been reached so far in regards to mortality, while there may be evidence of benefit for transfusion outcomes. Overall, evaluated outcomes were consistent with a benefit in favour of a TEG- or ROTEM-guided transfusion in bleeding patients.

Authors' conclusions: There is growing evidence that application of TEG- or ROTEM-guided transfusion strategies may reduce the need for blood products, and improve morbidity in patients with bleeding. However, these results are primarily based on trials of elective cardiac surgery involving cardiopulmonary bypass, and the level of evidence remains low. Further evaluation of TEG- or ROTEM-guided transfusion in acute settings and other patient categories in low risk of bias studies is needed.

PubMed Disclaimer

Conflict of interest statement

Anne Wikkelsø: Declares to have received thromboelastography (TEG) assays from Haemonetics Corp. but no financial support for a randomized controlled trial (RCT) investigating fibrinogen concentrate in postpartum haemorrhage with TEG used as haemostatic monitoring (trial not part of this review).

Arash Afshari: Declares to have received TEG assays from Haemonetics Corp. but no financial support for an RCT investigating fibrinogen concentrate in postpartum haemorrhage with TEG used as haemostatic monitoring (trial not part of this review).

Ann Merete Møller: Declares to have received TEG assays from Haemonetics Corp. but no financial support for an RCT investigating fibrinogen concentrate in postpartum haemorrhage with TEG used as haemostatic monitoring (trial not part of this review).

Jørn Wetterslev: Declares that he is a member of Trial Sequential Analysis (TSA) at Copenhagen Trial Unit developing and programming TSA.

Figures

1
1
Trial sequential analysis (TSA) of mortality shows that only 54% of the required information size (717 of 1325) for a 49% relative risk reduction (RRR) has been reached in a fixed‐effect model with continuity adjustment for zero event trials (0.001 in each arm) resulting in a TSA alfa‐boundary adjusted RR of 0.51 (95% CI 0.21 to 1.26, Diversity (D2) = 0%, I2 = 0%, fixed‐effect model) with a control event proportion of 7.4%. Cumulative Z‐curve does not cross the monitoring boundary constructed for a required information size of 1325 participants corresponding to a RRR of 49% with 80% power and alpha of 0.05. However, only two trials had low risk of bias, with insufficient event rate to carry out a separate meta‐analysis for low risk of bias trials. When carrying out the TSA by using random‐effects model instead of fixed‐effect model, the RR is 0.59 (95% CI 0.23 to 1.54, Diversity (D2) = 0%, I2 = 0%).
2
2
Trial Sequential Analysis (TSA) of all trials on the effect of haemostatic transfusion guided by TEG or ROTEM on the need for PRBCs resulted in a TSA alfa‐spending boundary adjusted RR of 0.86 (95% CI 0.79 to 0.95, D2= 0%, I2= 0%, fixed‐effect model) with a control event proportion of 93.3% with continuity adjustment for zero event trials (0.001 in each arm). Cumulative Z‐curve in blue crosses the monitoring boundary constructed for an adjusted information size of 507 participants corresponding to a RRR of 14% with 80% power and alpha of 0.05.
3
3
TSA of the effect of haemostatic transfusion guided by TEG or ROTEM on proportion of patients in need of FFP resulted in a TSA alfa‐spending boundary adjusted RR of 0.6 (95% CI 0.55 to 0.65) with the cumulative Z‐curve crossing the boundary constructed for an information size of 372 in the meta‐analysis with a RRR of 40% (alfa = 0.05) and a power of 80% (beta = 0.20) in a random‐effects model with high heterogeneity (I2 = 73%) and diversity (D2= 88%) and control group event rate of 47.1% with continuity adjustment for zero event trials (0.001 in each arm). However, one has to exert caution when interpreting indications of firm evidence for this outcome, since only two trials had low risk of bias (Nakayama 2015; Shore‐Lesserson 1999) and the required information size based on these two trials is 2921 and the cumulative Z‐curve does not cross the boundary.
4
4
TSA of all trials for the effect of haemostatic transfusion guided by TEG or ROTEM on the need for platelets indicates firm evidence and resulted in a TSA alfa‐spending boundary adjusted RR of 0.73 (95% CI 0.70 to 0.76, Diversity (D2) = 0%, I2 = 0%, fixed‐effect model) with a control event proportion of 34.4% and with continuity adjustment for zero event trials (0.001 in each arm). Cumulative Z‐curve crosses the monitoring boundary constructed for an adjusted information size of 177 participants corresponding to a RRR of 27% with 90% power and alpha of 0.05. However, as with previous analysis, only two trials had low risk of bias (Nakayama 2015; Shore‐Lesserson 1999) and the low‐risk of bias adjusted required information size is 1090 participants.
5
5
TSA of all trials for the effect of haemostatic transfusion guided by TEG or ROTEM on the need for re operations results in a TSA alfa‐spending boundary adjusted RR of 0.74 (CI 0.63 to 0.86, D2= 0%, I2 = 0%, fixed‐effect model) but the cumulative Z‐curve does not cross the monitoring boundary constructed for an adjusted information size of 516 participants corresponding to a RRR of 26% with 80% power and alpha of 0.05 and a control event proportion of 10.8% with continuity adjustment for zero event trials (0.001 in each arm). However, only trial was with low risk of bias.
6
6
Updated flow diagram for selection of randomized controlled trials up to 5 January 2016.
7
7
Updated flow diagram for selection of randomized controlled trials from 31 October 2010 to 5 January 5 2016.
8
8
Flow diagram for selection of randomized controlled trials up to 31 October 31 according to last published version of this review (Afshari 2011).
9
9
Updated risk of bias summary: review authors' judgements about each risk of bias item for each included study.
10
10
Updated risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 1 Mortality; grouped by TEG or ROTEM.
1.2
1.2. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 2 Mortality; grouped by coagulopathy or severe postoperative bleeding status.
1.3
1.3. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 3 Patients receiving PRBCs; grouped by TEG or ROTEM.
1.4
1.4. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 4 Patients receiving PRBCs; grouped by adult or paediatric patients.
1.5
1.5. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 5 Patients receiving PRBCs; grouped by coagulopathy or severe postoperative bleeding status.
1.6
1.6. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 6 Patients receiving FFP; grouped by TEG or ROTEM.
1.7
1.7. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 7 Patients receiving FFP; grouped by coagulopathy or severe postoperative bleeding status.
1.8
1.8. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 8 Patients receiving platelets; grouped by TEG or ROTEM.
1.9
1.9. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 9 Patients receiving platelets; grouped by adult or paediatric patients.
1.10
1.10. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 10 Patients receiving platelets; grouped by coagulopathy or severe postoperative bleeding status.
1.11
1.11. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 11 Transfusion of FFP & platelets.
1.12
1.12. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 12 Patients receiving fibrinogen concentrate.
1.13
1.13. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 13 Patients receiving prothrombin complex concentrate (PCC).
1.14
1.14. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 14 Patients receiving factor VIIa.
1.15
1.15. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 15 Surgical reintervention; grouped by coagulopathy or severe postoperative bleeding status.
1.16
1.16. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 16 Surgical reintervention; grouped by TEG or ROTEM.
1.17
1.17. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 17 Dialysis‐dependent renal failure.
1.18
1.18. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 18 Thrombotic events.
1.19
1.19. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 19 Surgical source of re‐bleeding.
1.20
1.20. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 20 Excessive bleeding events and massive transfusion.
1.21
1.21. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 21 Post hoc: mortality; grouped by comparison.
1.22
1.22. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 22 Post hoc: patients receiving PRBCs; grouped by comparisons.
1.23
1.23. Analysis
Comparison 1 TEG or ROTEM versus any comparison, Outcome 23 Post hoc: patients receiving FFP; grouped by comparison.
2.1
2.1. Analysis
Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 1 Mortality.
2.2
2.2. Analysis
Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 2 Patients receiving PRBCs.
2.3
2.3. Analysis
Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 3 Patients receiving FFP.
2.4
2.4. Analysis
Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 4 Patients receiving platelets.
2.5
2.5. Analysis
Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 5 Surgical reintervention.
3.1
3.1. Analysis
Comparison 3 TEG or ROTEM versus SLT‐guided transfusion, Outcome 1 Mortality.
3.2
3.2. Analysis
Comparison 3 TEG or ROTEM versus SLT‐guided transfusion, Outcome 2 Patients receiving PRBCs.
3.3
3.3. Analysis
Comparison 3 TEG or ROTEM versus SLT‐guided transfusion, Outcome 3 Patients receiving FFP.
3.4
3.4. Analysis
Comparison 3 TEG or ROTEM versus SLT‐guided transfusion, Outcome 4 Patients receiving platelets.
3.5
3.5. Analysis
Comparison 3 TEG or ROTEM versus SLT‐guided transfusion, Outcome 5 Surgical reintervention.
4.1
4.1. Analysis
Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 1 Mortality.
4.2
4.2. Analysis
Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 2 Patients receiving PRBCs.
4.3
4.3. Analysis
Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 3 Patients receiving FFP.
4.4
4.4. Analysis
Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 4 Patients receiving platelets.
4.5
4.5. Analysis
Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 5 Surgical reintervention.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Ak 2009 {published data only (unpublished sought but not used)}
    1. Ak K, Isbir CS, Tetik S, Atalan N, Tekeli A, Aljodi M, et al. Thromboelastography‐based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study. Journal of Cardiac Surgery 2009;24(4):404‐10. [PUBMED: 19583608] - PubMed
Avidan 2004 {published data only (unpublished sought but not used)}
    1. Avidan MS, Alcock EL, Fonseca J, Ponte J, Desai JB, Despotis GJ, et al. Comparison of structured use of routine laboratory tests or near‐patient assessment with clinical judgement in the management of bleeding after cardiac surgery. British Journal of Anaesthesia 2004;92(2):178‐86. [PUBMED: 14722166 ] - PubMed
Cui 2010 {published data only (unpublished sought but not used)}
    1. Cui Y, Hei F, Long C, Feng Z, Zhao J, Yan F, et al. Perioperative monitoring of thromboelastograph on blood protection and recovery for severely cyanotic patients undergoing complex cardiac surgery. Artificial Organs 2010;34(11):955‐60. [PUBMED: 21092037] - PubMed
Girdauskas 2010 {published data only (unpublished sought but not used)}
    1. Girdauskas E, Kempfert J, Kuntze T, Borger MA, Enders J, Fassl J, et al. Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial. Journal of Thoracic and Cardiovascular Surgery 2010;140(5):1117‐24. [PUBMED: 20951260] - PubMed
Kempfert 2011 {published data only (unpublished sought but not used)}
    1. Kempfert J. Thromboelastography‐guided blood component therapy after cardiac surgery: A randomised study. Interactive Cardiovascular and Thoracic Surgery 2011;13:S106‐7.
Kultufan Turan 2006 {published and unpublished data}
    1. Kultufan Turan S, Aydinli B, Ayik H, Yaar S, Kazanci D, Karadenz Ü, et al. The role of rotational thromboelastgraphy on decision of blood transfusion in open heart surgery [Açik Kalp Cerrahisinde TromboelastografininTransfüzyon Karari Üzerine Etkisi]. Göğüs‐Kalp‐Damar Anestezi ve Yoğun Bakım Derneği Dergisi 2006;12(4):154‐9.
Nakayama 2015 {published and unpublished data}
    1. Nakayama Y, Nakajima Y, Tanaka KA, Sessler DI, Maeda S, Iida J, et al. Thromboelastometry‐guided intraoperative haemostatic management reduces bleeding and red cell transfusion after paediatric cardiac surgery. British Journal of Anaesthesia 2015;114(1):91‐102. [PUBMED: 25303988] - PubMed
NCT00772239 {unpublished data only}
    1. NCT00772239. Perioperative coagulation management in cardiac surgery. (ROTEM). clinicaltrials.gov/ct2/show/NCT00772239 (first received 13 October 2008).
Nuttal 2001 {published data only (unpublished sought but not used)}
    1. Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;94(5):773‐81. [PUBMED: 11388527] - PubMed
Paniagua 2011 {published and unpublished data}
    1. Paniagua P, Koller T, Requena T, Gil JM, Campos JM, Galan J. Randomized controlled trial to evaluate postoperative coagulation management with bed‐side trombelastometry (Rotem) compared with a transfusion protocol based on laboratory measurements in bleeding patients after cardiac surgery: Preliminary data. European Journal of Anaesthesiology 2011;28:94.
Rauter 2007 {published data only (unpublished sought but not used)}
    1. Rauter M, Kästenbauer T, Schwarz S, Fitzgerald R. Reduced number of red blood cell transfusions in cardiac surgery due to perioperative coagulation testing by thromboelastometry. Acta Anaesthesiologica Scandinavica. 2007; Vol. 51 (Suppl 118):40.
Royston 2001 {published data only (unpublished sought but not used)}
    1. Royston D, Kier S. Reduced haemostatic factor transfusion using heparinase‐modified thrombelastography during cardiopulmonary bypass. British Journal of Anaesthesia 2001;86(4):575‐8. [PUBMED: 11573637] - PubMed
Schaden 2012 {published and unpublished data}
    1. Schaden E, Kimberger O, Kraincuk P, Baron DM, Metnitz PG, Kozek‐Langenecker S. Perioperative treatment algorithm for bleeding burn patients reduces allogeneic blood product requirements. British Journal of Anaesthesia 2012;109(3):376‐81. [PUBMED: 22719014] - PubMed
Shore‐Lesserson 1999 {published and unpublished data}
    1. Shore‐Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela‐Cantos F, Ergin MA. Thromboelastography‐guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesthesia and Analgesia 1999;88(2):312‐9. [PUBMED: 9972747] - PubMed
Wang 2010 {published data only (unpublished sought but not used)}
    1. Wang SC, Shieh JF, Chang KY, Chu YC, Liu CS, Loong CC. Thromboelastography‐guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. Transplant Proceedings 2010;42(7):2590‐3. [PUBMED: 20832550] - PubMed
Weber 2012 {published and unpublished data}
    1. Weber CF, Goerlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, et al. Point‐of‐care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012;117(3):531‐47. [ClinicalTrials.gov: NCT00997841; PUBMED: 22914710] - PubMed
Westbrook 2009 {published data only (unpublished sought but not used)}
    1. Westbrook AJ, Olsen J, Bailey M, Bates J, Scully M, Salamonsen RF. Protocol based on thromboelastograph (TEG) out‐performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study. Heart Lung and Circulation 2009;18(4):277‐88. [PUBMED: 19117801] - PubMed

References to studies excluded from this review

Anderson 2006 {published data only}
    1. Anderson L, Quasim I, Soutar R, Steven M, Macfie A, Korte W. An audit of red cell and blood product use after the institution of thrombelastometry in cardiac intensive care unit. Transfusion Medicine 2006;16:31‐9. [PUBMED: 16480437 ] - PubMed
    1. Anderson L, Quasim I, Steven M, Soutar R, Macfie A. An audit of red cell and blood products use after institution of thrombelastography in cardiac intensive care unit. British Journal of Haematology 2003;121(Suppl 1):80.
Andreasen 2011 {published data only}
    1. Andreasen JB, Hvas AM, Christiansen K, Ravn HB. Can RoTEM analysis be applied for haemostatic monitoring in paediatric congenital heart surgery?. Cardiology in the Young 2011;21(06):684‐91. [PUBMED: 21729518] - PubMed
Aoki 2012 {published data only}
    1. Aoki K, Sugimoto A, Nagasawa A, Saito M, Ohzeki H. Optimization of thromboelastography‐guided platelet transfusion in cardiovascular surgery. General Thoracic and Cardiovascular Surgery 2012;60(7):411‐6. [PUBMED: 22566265] - PubMed
Blasi 2012 {published data only}
    1. Blasi A, Beltran J, Pereira A, Martinez‐Palli G, Torrents A, Balust J, et al. An assessment of thromboelastometry to monitor blood coagulation and guide transfusion support in liver transplantation. Transfusion 2012;52(9):1989‐98. [PUBMED: 22304465] - PubMed
Coakley 2006 {published data only}
    1. Coakley M, Reddy K, Mackie I, Mallett S. Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests. Journal of Cardiothoracic and Vascular Anesthesia 2006;20(4):548‐53. [PUBMED: 16884987] - PubMed
Cui 2009 {published data only}
    1. Cui Y, Hei F, Long C, Feng Z, Zhao J, Yan F, et al. Perioperative monitoring of thromboelastograph on hemostasis and therapy for cyanotic infants undergoing complex cardiac surgery. Artificial Organs 2009;33(11):909‐14. [PUBMED: 20021469] - PubMed
De Pietri 2014 {published data only}
    1. Bianchini M, Pietri L, Maira T, Maria N, Begliomini B, Gerunda GE, et al. Thrombelastography decreases hemoderivates requirement before invasive procedures in cirrhotic patients with coagulation disorders. A randomized controlled trial. Hepatology. John Wiley and Sons Inc., 2013, issue 4 Suppl 1:292A‐3A.
    1. Pietri L, Bianchini M, Montalti R, Maria N, Maira T, Begliomini B, et al. Thrombelastography (TEG) decreases blood products requirement before invasive procedures in cirrhotic patients with coagulation tests derangement. A randomized controlled trial. Digestive and Liver Disease. 2014; Vol. 46:e5‐6.
    1. Pietri L, Bianchini M, Montalti R, Maira T, Maria N, Begliomini B, et al. 194 Thrombelastography before invasive procedures reduces hemoderivates requirements in cirrhotic patients with coagulation disorders. a randomized controlled trial. Journal of Hepatology 2013;58:S85‐6.
Dirkmann 2013 {published data only}
    1. Dirkmann D, Gorlinger K, Dusse F, Kottenberg E, Peters J. Early thromboelastometric variables reliably predict maximum clot firmness in patients undergoing cardiac surgery: A step towards earlier decision making. Acta Anaesthesiologica Scandinavica 2013;5:594‐603. [PUBMED: 23240733] - PubMed
Doran 2010 {published data only}
    1. Doran CM, Woolley T, Midwinter MJ. Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. Journal of Trauma 2010;69:S40‐8. [PUBMED: 20622618 ] - PubMed
Dua 2005 {published data only}
    1. Dua K, Singh J, Chatterji C, Makroo R, Das BS. Blood component therapy in postoperative OBCAB (off pump coronary artery bypass surgery) patients: Our experiences with thromboelastography (TEG). Vox Sanguinis 2005;89 Suppl 2:5P‐144.
El 2009 {published data only}
    1. Kady N, Khedr H, Yosry M, Mekawi S. Perioperative assessment of coagulation in paediatric neurosurgical patients using thromboelastography. European Journal of Anaesthesiology 2009;26(4):293‐7. [PUBMED: 19401660] - PubMed
Faraoni 2013 {published data only}
    1. Faraoni D, Savan V, Levy JH, Theusinger OM. Goal‐directed coagulation management in the perioperative period of cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2013;27(6):1347‐54. [PUBMED: 24103717] - PubMed
Gorlinger 2011a {published data only}
    1. Gorlinger K, Dirkmann D, Hanke AA, Kamler M, Kottenberg E, Thielmann M, et al. First‐line therapy with coagulation factor concentrates combined with point‐of‐care coagulation testing Is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single‐center cohort study. Anesthesiology 2011;115(6):1179‐91. [PUBMED: 21970887] - PubMed
Gorlinger 2011b {published data only}
    1. Gorlinger K, Dirkmann D, Rahe‐Meyer N, Weber CF, Hanke AA. Algorithms for transfusion and coagulation management in massive haemorrhage. Anasthesiologie und Intensivmedizin 2011;52(2):145‐59.
Gronchi 2014 {published data only}
    1. Gronchi F, Perret A, Ferrari E, Marcucci CM, Fleche J, Crosset M, et al. Validation of rotational thromboelastometry during cardiopulmonary bypass: A prospective, observational in‐vivo study. European Journal of Anaesthesiology 2014;31(2):68‐75. - PubMed
Haas 2015 {published data only}
    1. Haas T, Spielmann N, Restin T, Seifert B, Henze G, Obwegeser J, et al. Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial. British Journal of Anaesthesia 2015;115(2):234‐43. [PUBMED: 25982134] - PubMed
Hanke 2012 {published data only}
    1. Hanke AA, Herold U, Dirkmann D, Tsagakis K, Jakob H, Gorlinger K. Thromboelastometry based early goal‐directed coagulation management reduces blood transfusion requirements, adverse events, and costs in acute Type A aortic dissection: A pilot study. Transfusion Medicine and Hemotherapy 2012;39(2):121‐8. [PUBMED: 22670130] - PMC - PubMed
    1. Hanke AA, Herold U, Dirkmann D, Tsagakis K, Jakob H, Gorlinger K. Thromboelastometry based early goal‐directed coagulation management reduces blood transfusion requirements, adverse events, and costs in acute type A aortic dissection: A pilot study. Transfusion Medicine and Hemotherapy 2012;39(2):121‐8. [PUBMED: 22670130] - PMC - PubMed
Hill 2012 {published data only}
    1. Hill JS, Devenie G, Powell M. Point‐of‐care testing of coagulation and fibrinolytic status during postpartum haemorrhage: developing a thrombelastography‐guided transfusion algorithm. Anaesthesia and Intensive Care 2012;40(6):1007‐15. [PUBMED: 23194210] - PubMed
Howland 1974 {published data only}
    1. Howland WS, Schweizer O, Gould P. A comparison of intraoperative measurements of coagulation. Anesthesia and Analgesia 1974;53(5):657‐63. [PUBMED: 4606102] - PubMed
Hvas 2012 {published data only}
    1. Hvas A‐M, Boas TW, Jensen M, Lindskov C, Folkersen L, Ravn HB. Change in hemostatic intervention after implementation of thromboelastometry. Journal of Cardiothoracic and Vascular Anesthesia 2012, issue 2:227‐31. [PUBMED: 21924638] - PubMed
Jambor 2009 {published data only}
    1. Jambor C, Spannagl M, Zwissler B. Perioperative management of patients with coronary stents in non‐cardiac surgery. Anaesthesist 2009;58(10):971‐85. [PUBMED: 19823781] - PubMed
Johansson 2007 {published data only}
    1. Johansson PIM. The blood bank: From provider to partner in treatment of massively bleeding patients. Transfusion 2007;47 Suppl(2):176‐81. [PUBMED: 17651347] - PubMed
Johansson 2009 {published data only}
    1. Johansson PI, Stensballe J. Effect of Haemostatic Control Resuscitation on mortality in massively bleeding patients: A before and after study. Vox Sanguinis 2009;96(2):111‐8. [PUBMED: 19152603] - PMC - PubMed
Kunio 2012 {published data only}
    1. Kunio NR, Differding JA, Watson KM, Stucke RS, Schreiber MA. Thrombelastography‐identified coagulopathy Is associated with increased morbidity and mortality after traumatic brain injury. American Journal of Surgery 2012;203(5):584‐8. [PUBMED: 22425448] - PubMed
Mendeloff 2009 {published data only}
    1. Mendeloff EN, Glenn GF, Tavakolian P, Lin E, Leonard A, Prince SL, et al. The role of thromboelastography in directing blood product usage in infant open heart surgery. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 2009;4(5):282‐90. [DOI: 10.1097/IMI.0b013e3181bbd4ff] - DOI - PubMed
Naik 2015 {published data only}
    1. Naik BI, Pajewski TN, Bogdonoff DI, Zuo Z, Clark P, Terkawi Abdullah S, et al. Rotational thromboelastometry‐guided blood product management in major spine surgery. Journal of Neurosurgery. Spine 2015;23(2):239‐49. [PUBMED: 26053893] - PubMed
NCT01218074 {published data only}
    1. NCT01218074. Platelets antiaggregation control enhancement (PACE) study. clinicaltrials.gov/ct2/show/NCT01218074 (first received 5 October 2010).
Ogawa 2012 {published data only}
    1. Ogawa S, Szlam F, Chen EP, Nishimura T, Kim H, Roback JD, et al. A comparative evaluation of rotation thromboelastometry and standard coagulation tests in hemodilution‐induced coagulation changes after cardiac surgery. Transfusion 2012;52(1):14‐22. [PUBMED: 21756263] - PubMed
Ploppa 2010 {published data only}
    1. Ploppa A, Unertl KE, Nohe B. Thrombelastometry‐guided thrombolytic therapy in massive pulmonary artery embolism. Acta Anaesthesiologica Scandinavica 2010;54(9):1145‐8. [PUBMED: 20670312] - PubMed
Rafiq 2012 {published data only}
    1. Rafiq S, Johansson PI, Zacho M, Stissing T, Kofoed K, Lilleor NB, et al. Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery (TEG‐CABG trial): assessing and monitoring the antithrombotic effect of clopidogrel and aspirin versus aspirin alone in hypercoagulable patients. Trials. BioMed Central Ltd. (Floor 6, 236 Gray's Inn Road, London WC1X 8HB, United Kingdom), 2012; Vol. 13:48. [Clinical trials NCT01046942.; PUBMED: 22540524] - PMC - PubMed
Rahe‐Meyer 2009a {published data only}
    1. Rahe‐Meyer N, Pichlmaier M, Haverich A, Solomon C, Winterhalter M, Piepenbrock S, et al. Bleeding management with fibrinogen concentrate targeting a high‐normal plasma fibrinogen level: a pilot study. British Journal of Anaesthesia 2009;102(6):785‐92. [PUBMED: 19698858] - PMC - PubMed
Rahe‐Meyer 2009b {published data only}
    1. Rahe‐Meyer N, Solomon C, Winterhalter M, Piepenbrock S, Tanaka K, Haverich A, et al. Thromboelastometry‐guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery. Journal of Thoracic and Cardiovascular Surgery 2009;138(3):694‐702. [PUBMED: 19698858] - PubMed
Roullet 2014 {published data only}
    1. Roullet S, Freyburger G, Cruc M, Quinart A, Stecken L, Audy M, et al. Management of bleeding and transfusion during liver transplantation before and after the introduction of a ROTEM‐based algorithm. Liver Transplantation 2014;21(2):169‐79. [PUBMED: 25331016] - PubMed
Schochl 2010 {published data only}
    1. Schochl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, et al. Goal‐directed coagulation management of major trauma patients using thromboelastometry (ROTEM)‐guided administration of fibrinogen concentrate and prothrombin complex concentrate. Critical Care 2010;14(2):R55. [PUBMED: 20374650] - PMC - PubMed
Schochl 2011 {published data only}
    1. Scochl H, Nienaber U, Maegele M, Hochleitner G, Primavesi F, Steitz B, et al. Transfusion in trauma: thromboelastometry‐guided coagulation factor concentrate‐based therapy versus standard fresh frozen plasma‐based therapy. Critical Care 2011;15(2):R83. [PUBMED: 21375741] - PMC - PubMed
Schochl 2014 {published data only}
    1. Schochl H, Schlimp CJ, Voelckel W. Perioperative coagulation management in multiple trauma patients based on viscoelastic test results. Unfallchirurg 2014;117(2):111‐7. [PUBMED: 24482057] - PubMed
Smart 2015 {published data only}
    1. Smart L, Scharpf DT, Gray NO, Traetow D, Black S, Michaels A, et al. Rotational thromboelastometry (ROTEM) versus conventional coagulation tests during orthotopic liver transplantation: Comparison of intra‐operative blood loss, transfusion requirements, and cost. Hepatology. 2015; Vol. 62 Suppl 1:832A.
Solomon 2012 {published data only}
    1. Solomon C, Schoechl H, Hagl C, Rahe‐Meyer N. Fibrinogen concentrate as first‐line haemostatic therapy during aortic replacement surgery. A randomised trial. Journal of Thrombosis and Haemostasis 2012, issue 6:e7.
Spalding 2007 {published data only}
    1. Spalding GJ, Hartrumpf M, Sierig T, Oesberg N, Kirschke CG, Albes JM. Cost reduction of perioperative coagulation management in cardiac surgery: value of 'bedside' thrombelastography (ROTEM). European Journal of Cardio‐thoracic Surgery 2007;31(6):1052‐7. [PUBMED: 17516038] - PubMed
Spiess 1995 {published data only}
    1. Spiess BD, Gillies BS, Chandler W, Verrier E. Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients. Journal of Cardiothoracic and Vascular Anesthesia 1995;9(2):168‐73. [PUBMED: 7780073 ] - PubMed
Tapia 2013 {published data only}
    1. Tapia NM, Chang A, Norman M, Welsh F, Scott B, Wall MJ Jr, et al. TEG‐guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients. Journal of Trauma and Acute Care Surgery 2013;74(2):378‐86. - PubMed
Urwyler 2012 {published data only}
    1. Urwyler N, Theiler L, Hirschberg M, Kleine‐Brueggeney M, Colucci G, Greif R. Standard vs. point‐of‐care measurement of fibrinogen: Potential impact on clinical decisions. Minerva Anestesiologica 2012; Vol. 78, issue 5:550‐5. - PubMed
Vaidya 2007 {published data only}
    1. Vaidya A, Muthusamy AS, Hadjianastassiou VG, Roy D, Elker DE, Moustafellos P, et al. Simultaneous pancreas‐kidney transplantation: To anticoagulate or not? Is that a question?. Clinical Transplantation 2007;21(4):554‐7. [PUBMED: 17645719] - PubMed
Wang 2012 {published data only}
    1. Wang SC, Lin HT, Chang KY, Mandell MS, Ting CK, Chu YC, et al. Use of higher thromboelastogram transfusion values is not associated with greater blood loss in liver transplant surgery. Liver Transplantation 2012;18(10):1254‐8. [PUBMED: 22730210] - PubMed

References to ongoing studies

NCT01402739 {published data only}
    1. NCT01402739. Algorithm‐guided transfusions in cardiac surgery patients for reduction of drainage blood losses (HEART‐PoC). clinicaltrials.gov/ct2/show/NCT01402739 (first received 25 July 2011).
NCT01536496 {published data only}
    1. NCT01536496. Comparison of rapid thrombelastography and conventional coagulation testing for haemostatic resuscitation in trauma. clinicaltrials.gov/ct2/show/NCT01536496 (first received 19 July 2011).
NCT02352181 {published data only}
    1. NCT02352181. Management of coagulopathy during orthotopic liver transplantation. comparison between ROTEM‐based management and standard biological assessment. clinicaltrials.gov/ct2/show/NCT02352181 (first received 18 December 2014).
NCT02416817 {published data only}
    1. NCT02416817. Strategy of transfusion in trauma patients ‐ STATA trial (STATA). clinicaltrials.gov/ct2/show/NCT02416817 (first received 28 August 2014).
NCT02461251 {published data only}
    1. NCT02461251. Thromboelastometry‐guided treatment protocol versus standard care of major haemorrhage in obstetric patients (ROTEM‐PPH). clinicaltrials.gov/ct2/show/NCT02461251 (first received 29 May 2015).
NCT02593877 {published data only}
    1. NCT02593877. Implementing treatment algorithms for the correction of trauma induced coagulopathy (iTACTIC). clinicaltrials.gov/ct2/show/NCT02593877 (first received 15 October 2015).

Additional references

AAGBI 2010
    1. Thomas D, Wee M, Clyburn P, Walker I, Brohi K, Collins P, et al. AAGBI (Association of Anaesthetists of Great Britain and Ireland). Blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia 2010;65(11):1153‐61. [PUBMED: 20963925] - PMC - PubMed
Altman 2003
    1. Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ 2003;326(7382):219. [PUBMED: 12543843] - PMC - PubMed
Benes 2015
    1. Benes J, Zatloukal J, Kletecka J. Viscoelastic methods of blood clotting assessment ‐ a multidisciplinary review. Frontiers in Medicine 2015;2:62. [PUBMED: 26442265] - PMC - PubMed
Besser 2010
    1. Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Critical Reviews in Clinical Laboratory Sciences 2010;47(5‐6):197‐212. [PUBMED: 21391830] - PubMed
Bolliger 2013
    1. Bolliger D, Tanaka KA. Roles of thrombelastography and thromboelastometry for patient blood management in cardiac surgery. Transfusion Medicine Reviews 2013;27(4):213‐20. [PUBMED: 24075802] - PubMed
Brohi 2008
    1. Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. The Journal of Trauma 2008;64(5):1211‐7. [PUBMED: 18469643] - PubMed
Brok 2009
    1. Brok J, Thorlund K, Wetterslev J, Gluud C. Apparently conclusive meta‐analyses may be inconclusive‐Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta‐analyses. Journal of Clinical Epidemiology 2009;38(1):287‐98. [PUBMED: 18824466] - PubMed
Chan 2004
    1. Chan AW, Hróbjartsson A, Haahr MT, Gøtzsche PC, Altman DG. Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA 2004;291(20):2457‐65. [PUBMED: 15161896] - PubMed
Chee 2003
    1. Chee YL, Greaves M. Role of coagulation testing in predicting bleeding risk. The Hematology Journal 2003;4(6):373‐8. [PUBMED: 14671609] - PubMed
Corredor 2015
    1. Corredor C, Wasowicz M, Karkouti K, Sharma V. The role of point‐of‐care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta‐analysis. Anaesthesia 2015;70(6):715‐31. [PUBMED: 25916344] - PubMed
Craig 2007
    1. Craig J, Aguiar‐Ibanez R, Bhattacharya S, Downie S, Duffy S, Kohli H, et al. The clinical and cost effectiveness of thromboelastography/thromboelastometry. Health Technology Assessment, Report 11. www.nhshealthquality.org (accessed January 2016).
De Robertis 2015
    1. Robertis E, Kozek‐Langenecker SA, Tufano R, Romano GM, Piazza O, Zito Marinosci G. Coagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding. Minerva Anestesiologica 2015;81(1):65‐75. [PUBMED: 24608516] - PubMed
Dickersin 1990
    1. Dickersin K. The existence of publication bias and risk factors for its occurrence. JAMA 1990;263(10):1359‐85. [PUBMED: 2406472] - PubMed
Gluud 2005
    1. Gluud C, Gluud LL. Evidence based diagnostics. BMJ 2005;330(7493):724‐6. [PUBMED: 15790646] - PMC - PubMed
Gotzsche 2000
    1. Gotzsche PC. Why we need a broad perspective on meta‐analysis. It may be crucially important for patients. BMJ 2000;321(7261):585–6. [PUBMED: 10977820] - PMC - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed.) 2008;336(7650):924‐6. [PUBMED: 18436948] - PMC - PubMed
Hardy 2004
    1. Hardy JF, Moerloose P, Samama M, Groupe d'intérêt en Hémostase Périopératoire. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Canadian Journal of Anaesthesia 2004;51(4):293‐310. [PUBMED: 15064258] - PubMed
Hardy 2005
    1. Hardy JF, Moerloose P, Samama CM. The coagulopathy of massive transfusion. Vox Sanguinis 2005;89(3):123‐7. [PUBMED: 16146503] - PubMed
Hartert 1948
    1. Hartert. Blutgerinnungsstudien mit der Thrombelastographie, einem neuen Untersuchungsverfahren. Klinische Wochenschrift 1948;26(37‐38):577‐83. [PUBMED: 18101974] - PubMed
Hartmann 2006
    1. Hartmann M, Sucker C, Boehm O, Koch A, Loer S, Zacharowski K. Effects of cardiac surgery on hemostasis. Transfusion Medicine Reviews 2006;20(3):230‐41. [PUBMED: 16787830] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [PUBMED: 12958120] - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org.
Hiippala 1995
    1. Hiippala ST, Myllyla GJ, Vahtera EM. Hemostatic factors and replacement of major blood loss with plasma‐poor red cell concentrates. Anesthesia and Analgesia 1995;81(2):360‐5. [PUBMED: 7542432] - PubMed
Hunt 2015
    1. Hunt H, Stanworth S, Curry N, Woolley T, Cooper C, Ukoumunne O, et al. Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma‐induced coagulopathy in adult trauma patients with bleeding. Cochrane Database of Systematic Reviews 2015, Issue 2. [DOI: 10.1002/14651858.CD010438.pub2; PUBMED: 25686465] - DOI - PMC - PubMed
Hutton 2000
    1. Hutton JL, Williamson PR. Bias in meta‐analysis due to outcome variable selection within studies. Journal of the Royal Statistical Society Series C 2000;49:359‐70. [PUBMED: 16248351] - PubMed
Johansson 2012
    1. Johansson PI, Stensballe J, Ostrowski SR. Current management of massive hemorrhage in trauma. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012;20(1):47. [PUBMED: 22776724] - PMC - PubMed
Johansson 2014
    1. Johansson PI, Stensballe J, Oliveri R, Wade CE, Ostrowski SR, Holcomb JB. How I treat patients with massive hemorrhage. Blood 2014;124(20):3052‐8. [PUBMED: 25293771] - PubMed
Kozek‐Langenecker 2007
    1. Kozek‐Langenecker S. Management of massive operative blood loss. Minerva Anestesiologica 2007;73(7‐8):401‐15. [PUBMED: 17380100] - PubMed
Lan 1983
    1. Lan KKG, DeMets DL. Discrete sequential boundaries for clinical trials. Biometrika 1983;70:659‐63.
Lang 2005
    1. Lang T, Bauters A, Braun SL, Pötzsch B, Pape KW, Kolde HJ, et al. Multi‐centre investigation on reference ranges for ROTEM thromboelastometry. Blood Coagulation & Fibrinolysis 2005;16(4):301‐10. [PUBMED: 15870552] - PubMed
Levrat 2008
    1. Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, et al. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. British Journal of Anaesthesia 2008;100(6):792‐7. [PUBMED: 18440953] - PubMed
Luddington 2005
    1. Luddington RJ. Thrombelastography/thromboelastometry. Clinical and Laboratory Haematology 2005;27(2):81‐90. [PUBMED: 15784122] - PubMed
Paparella 2004
    1. Paparella D, Brister SJ, Buchanan MR. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Medicine 2004;30(10):1873‐81. [PUBMED: 15278267] - PubMed
Pogue 1997
    1. Pogue JM, Yusuf S. Cumulating evidence from randomized trials: Utilizing sequential monitoring boundaries for cumulative meta‐analysis. Controlled Clinical Trials 1997;18(6):580‐93. [PUBMED: 9408720] - PubMed
Pogue 1998
    1. Pogue J, Yusuf S. Overcoming the limitations of current meta‐analysis of randomized controlled trials. Lancet 1998;351(9095):45‐52. [PUBMED: 9433436] - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Roth 2016
    1. Roth D, Heidinger B, Havel C, Herkner H. Different mortality time points in critical care trials: current practice and influence on effect estimates in meta‐analyses. Critical Care Medicine 2016;44(8):e737‐41. [PUBMED: 26963325] - PubMed
Rugeri 2007
    1. Rugeri L, Levrat A, David JS, Delecroix E, Floccard B, Gros A, et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. Journal of Thrombosis and Haemostasis 2007;5(2):289‐95. [PUBMED: 17109736] - PubMed
Sabate 2012
    1. Sabate A, Dalmau A, Koo M, Aparicio I, Costa M, Contreras L. Coagulopathy management in liver transplantation. Transplantation Proceedings 2012;44(6):1523‐5. [PUBMED: 22841202] - PubMed
Segal 2005
    1. Segal JB, Dzik WH. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence‐based review. Transfusion 2005;45(9):1413‐25. [PUBMED: 16131373] - PubMed
Sutton 2002
    1. Sutton AJ, Cooper NJ, Lambert PC, Jones DR, Abrams KR, Sweeting MJ. Meta‐analysis of rare and adverse event data. Expert Review of Pharmacoeconomics and Outcomes Research 2002;2(4):367‐79. [PUBMED: 19807443] - PubMed
Thorlund 2009
    1. Thorlund K, Devereaux PJ, Wetterslev J, Guyatt G, Ioannidis JP, Thabane L, et al. Can trial sequential monitoring boundaries reduce spurious inferences from meta‐analyses?. International Journal of Clinical Epidemiology 2009;38(1):276‐86. [PUBMED: 18824467] - PubMed
TSA 2010 [Computer program]
    1. Wetterslev J, Thorlund K, Brok J, Gluud C. Trial Sequential Analysis. Version 0.8. Copenhagen: Copenhagn Trial Unit, 2010.
Wetterslev 2008
    1. Wetterslev J, Thorlund K, Brok J, Gluud C. Trial sequential analysis may establish when firm evidence is reached in cumulative meta‐analysis. International Journal of Clinical Epidemiology 2008;61(1):64‐75. [PUBMED: 18083463] - PubMed
Wetterslev 2009
    1. Wetterslev J, Thorlund K, Brok J, Gluud C. Estimating required information size by quantifying diversity in random‐effects model meta‐analyses. Bio Medical Central: Medical Research Methodology 2009;30(9):86. [PUBMED: 20042080] - PMC - PubMed
Whiting 2015
    1. Whiting P, Al M, Westwood M, Ramos IC, Ryder S, Armstrong N, et al. Viscoelastic point‐of‐care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost‐effectiveness analysis. Health Technology Assessment 2015;19(58):1‐228. [PUBMED: 26215747] - PMC - PubMed

References to other published versions of this review

Afshari 2009
    1. Afshari A, Wikkelsø A, Brok J, Møller AM, Wetterslev J. Thrombelastography (TEG) or Thrombelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD007871] - DOI - PubMed
Afshari 2011
    1. Afshari A, Wikkelsø A, Brok J, Møller AM, Wetterslev J. Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD007871.pub2] - DOI - PubMed
Wikkelsø 2017
    1. Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: a systematic review with meta‐analysis and trial sequential analysis. Anaesthesia 2017;epub ahead of print. [DOI: 10.1111/anae.13765] - DOI - PubMed

Publication types