This “Pro” argument supports the routine incorporation of point-of-care viscoelastic testing (VET) into perioperative bleeding management algorithms for all cardiac surgery patients. This group of patients remains among the highest consumers of allogeneic blood products, and transfusion is independently associated with increased morbidity, mortality, and cost. Standard laboratory tests have significant limitations in diagnosing coagulopathy and are not designed to guide intraoperative bleeding management. VET enables rapid identification of specific coagulation abnormalities and supports targeted hemostatic therapy. Current evidence demonstrates reductions in transfusion requirements, postoperative bleeding, acute kidney injury, and healthcare costs when VET is integrated into structured transfusion algorithms. Although limitations exist, the available evidence and contemporary guidelines support the routine implementation of VET in cardiac surgical programs.
Viscoelastic testing (VET) has become an important tool in cardiac surgery, particularly within bleeding management algorithms. However, evidence supporting its benefits largely pertains to patients with active bleeding rather than its use in all cases. VET does not reliably predict bleeding or transfusion requirements when performed preoperatively, and its indiscriminate application may lead to unnecessary blood product administration and increased costs. Randomized trials and meta-analyses consistently show that VET improves outcomes when integrated into structured blood management algorithms after bleeding is clinically evident. Established clinical predictors and standard laboratory tests remain effective for assessing bleeding risk, and recent expert guidelines explicitly discourage routine VET for all cardiac surgery patients. Selective use of VET in patients with suspected coagulopathy preserves its clinical benefits, minimizes harm, and aligns with evidence-based practice.
