Can the use of thromboelastography predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of thromboelastography could predict and decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery. Altogether 170 papers were identified using the reported search strategy of which 14 represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that thromboelastography may be useful in predicting patients who are likely to bleed postoperatively but more importantly, it can guide transfusion therapy algorithms in the bleeding cardiac surgical patient resulting in significant decreases in blood and blood component transfusion requirements. However, the technique remains unvalidated in the eyes of many haematologists and further large studies involving them are required to fully validate its use and to define the 'ideal' treatment algorithm.