Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis

Editor—With great interest we read the systematic review and meta-analysis on the routine use of viscoelastic haemostatic assays (VHA) for diagnosis and treatment of coagulopathic bleeding in cardiac surgery published by Serraino and Murphy.¹ Significant reductions in red blood cell transfusion requirements by the use of VHA have been confirmed by previous Cochrane reviews.²³ Reducing the exposure to allogeneic blood products is a clear perioperative management goal improving patient outcome and recommended by evidence-based bleeding guidelines.⁴ Moreover, Serraino and Murphy report significant reductions in platelet transfusion and plasma transfusion (RR 0.78, 95% CI 0.66–0.93; P=0.004), which is also clinically highly relevant considering specific transfusion-associated risks. Most importantly, the authors also report a significant reduction in acute renal failure (RR 0.42, 95% CI 0.20–0.86; P=0.02). Causality cannot be identified by meta-analyses, but acute renal failure has been shown to be associated with a significant increase in long-term mortality in cardiac and noncardiac surgery.^5–8

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