Secondary Outcomes Across Included Studies in TEG/ROTEM vs Control Groups

Across the seven randomized controlled trials included in this review, viscoelastic-guided transfusion strategies (TEG or ROTEM) were consistently associated with improved secondary clinical outcomes compared to conventional laboratory-based protocols. Reoperation for bleeding was reported in six of the seven studies. Rates were consistently lower in the intervention groups: Westbrook et al. (2009) reported 2/20 (10%) vs 4/20 (20%); Girdauskas et al. (2010) 5/60 (8.3%) vs 9/60 (15%); Haensig et al. (2019) 3/50 (6%) vs 6/50 (12%); Weber et al. (2012) 6/58 (10.3%) vs 11/58 (19%); Shore-Lesserson et al. (1999) 4/45 (8.9%) vs 7/45 (15.6%); and Ak et al. (2009) 3/40 (7.5%) vs 6/40 (15%). The pooled relative risk indicated a beneficial trend favoring the TEG/ROTEM group, with moderate heterogeneity (I² = 41%). These findings suggest a reduction in the need for reoperation, a key marker of perioperative hemostatic failure.ICU length of stay was modestly reduced in three trials. Westbrook et al. (2009) reported a mean ICU stay of 2.1 days in the TEG group versus 2.6 in the control group; Weber et al. (2012) reported 1.9 vs 3.1 days; and Karrar et al. (2022) observed 2.2 vs 3.0 days. The pooled mean difference was -0.64 days (95% CI: -1.41 to 0.13; I² = 47%), indicating a potential but not statistically significant reduction in ICU stay duration. Variability in ICU admission and discharge protocols may have contributed to between-study heterogeneity.Thromboembolic events were rare and numerically lower in the intervention groups. Westbrook et al. (2009) reported 0/20 vs 1/20 (5%); Weber et al. (2012) 0/58 vs 2/58 (3.4%); Ak et al. (2009) 0/40 vs 1/40 (2.5%); and Girdauskas et al. (2010) 0/60 vs 1/60 (1.7%). Other studies did not report thromboembolic complications. Due to the low number of events, no formal meta-analysis was conducted for this endpoint. Importantly, none of the trials showed an increased thrombotic risk with viscoelastic-guided management.These findings support the role of TEG/ROTEM-guided transfusion algorithms in reducing perioperative bleeding complications and possibly ICU resource utilization, without increasing thromboembolic risks.