Bleeding is a leading cause of perioperative mortality [1]. In a perioperative setting, damage control surgery with massive transfusion protocols (MTPs) are therapeutic approaches used clinically to manage patients with major bleeding. Massive transfusion is arbitrarily defined as receiving 10 or more red blood cell units in 24 h. MTPs include blood components or whole blood, along with coagulation factor concentrates, including prothrombin complex concentrates (PCCs) and fibrinogen, and are often based on a bleeding management algorithm that may include tranexamic acid, an antifibrinolytic agent [2]. To guide bleeding management, coagulation monitoring includes conventional coagulation tests (e.g., platelet counts, prothrombin time, and fibrinogen level), and/or viscoelastic testing (VET). In addition, haemostatic support is used to optimize haemostasis, while surgeons correct the site-specific bleeding, a strategy that requires collaboration among multiple clinicians, blood services, and in-hospital logistics. In this review, we will examine therapeutic approaches for haemostatic management during perioperative bleeding.