SummaryBackgroundPatients undergoing major surgery frequently experience major uncontrolled bleeding. The aim of this systematic review and meta‐analysis was to evaluate the clinical efficacy of using viscoelastic haemostatic assays to manage peri‐operative bleeding in elective surgery.MethodsWe searched PubMed/MEDLINE and Embase databases for randomised controlled trials according to pre‐determined criteria. The primary outcomes were blood product requirements; duration of stay in the operating theatre or ICU; and surgical reintervention rate.ResultsWe included 20 randomised controlled trials. The overall risk of bias was low to moderate. Twelve studies used thromboelastography‐based transfusion algorithms, while eight used thromboelastometry. Viscoelastic haemostatic assay‐guided therapy was associated with a statistically significant reduction in transfusion of red blood cells (standardised mean difference (95%CI) 0.16 (‐0.29 to 0.02)), platelets (standardised mean difference (95%CI) ‐0.33 (‐0.56 to ‐0.10)) and fresh frozen plasma (standardised mean difference (95%CI) ‐0.64 (‐1.01 to ‐0.28)). There was no evidence of an effect of viscoelastic haemostatic assay‐guided therapy on surgical reintervention (relative risk (95%CI) 1.09 (0.70–1.69)). Viscoelastic haemostatic assay‐guided therapy was associated with lower blood loss and shorter ICU duration of stay. There was no evidence of any effect on total duration of stay and all‐cause mortality.ConclusionsViscoelastic haemostatic assay‐guided therapy may reduce peri‐operative blood product transfusion requirements and blood loss during major elective surgery, with no discernible effect on patient‐centred outcomes. The overall quality of evidence was modest.

中文翻译：

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粘弹性止血试验指导择期手术治疗：更新的系统评价和荟萃分析


摘要背景接受大手术的患者经常出现不受控制的大出血。本系统评价和荟萃分析的目的是评估使用粘弹性止血测定法治疗择期手术围手术期出血的临床疗效。方法我们根据预先确定的标准检索了 PubMed/MEDLINE 和 Embase 数据库的随机对照试验。主要结局是血液制品需求;在手术室或 ICU 的停留时间;和手术再介入率。结果我们纳入了 20 项随机对照试验。总体偏倚风险为低到中等。12 项研究使用基于血栓弹力图的输血算法，而 8 项研究使用血栓弹力测定法。粘弹性止血试验指导治疗与红细胞输注 （标准化均数差 （95%CI） 0.16 （-0.29 至 0.02））、血小板 （标准化均数差 （95%CI） -0.33 （-0.56 至 -0.10）） 和新鲜冰冻血浆 （标准化均数差 （95%CI） - 0.64 （-1.01 至 -0.28）） 的输注减少相关。没有证据表明粘弹性止血试验指导治疗对手术再干预有影响 （相对风险 （95%CI） 1.09 （0.70–1.69））。粘弹性止血试验指导治疗与较低的失血量和较短的 ICU 住院时间相关。没有证据表明对总住院时间和全因死亡率有任何影响。结论粘弹性止血测定指导治疗可能会减少围手术期血液制品输注需求和大择期手术期间的失血量，但对以患者为中心的结局没有明显影响。证据的总体质量为中等。