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Viscoelastic Assays Versus Massive Transfusion Protocols: A Pro/Con Debate

Nathan, Naveen MD

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doi: 10.1213/ANE.0000000000005827

Managing blood loss during acute trauma currently employs fixed-ratio massive transfusion protocols. The importance of maintaining organ perfusions pressure, oxygen carrying capacity, normovolemia, and sufficient hemostatic integrity cannot be underscored enough. However, the potential risks of overtransfusion are also recognized. In this issue of Anesthesia & Analgesia, a pro-con argument is offered that considers an approach to massive transfusion driven by viscoelastic hemostatic assays rather than fixed-ratio blood product administration. The premise would be to avoid overtransfusing patients by letting the hemostatic profile of VHAs direct, which differential products are indicated. As seen in this infographic, the authors detail the potential benefits versus limitations of using such an approach. An accompanying editorial by Herbstreit et al convenes on an overarching view of how VHAs can benefit current management of massive transfusion during trauma until further research illuminates whether they can be the primary drivers of the process.


    1. Blaine KP, Dudaryk R. Pro-Con debate: viscoelastic hemostatic assays should replace fixed ratio massive transfusion protocols in trauma. Anesth Analg. 2022;134:21–31.
    2. Herbstreit F, Grissom TE, Pivalizza EG. Viscoelastic hemostatic assays in trauma: and the winner is.... Anesth Analg. 2022;134:19–20.
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