Imagine facing heart surgery. You want to know if the team will give you the right blood products to keep you safe. A large review looked at this exact question. It compared using special blood tests called TEG and ROTEM to guide transfusions against standard care. These tests measure how well your blood clots in real time. Standard care relies on clinical judgment and regular lab tests. The review included 3096 adults and children who had elective cardiac surgery. Elective means the surgery was planned in advance, not an emergency. The main goal was to see if the new testing changed the risk of dying from any cause.
The data showed a reduction in the risk of death. The group using the new tests had fewer deaths than those on standard care. They also had less bleeding overall. The need for fresh frozen plasma and platelet transfusions went down too. The risk of needing another surgery dropped as well. However, the need for packed red blood cells did not change significantly between the two groups.
But there is a major catch. The evidence is very uncertain. The results were primarily based on adults having elective heart surgery. We do not know if these findings apply to neonates, trauma patients, or those with sepsis. The certainty of the evidence is very low. Large, low risk of bias randomised controlled trials are needed across diverse clinical settings. Until then, we cannot say for sure if these tools work for everyone.