Rotational thromboelastometry‐guided
transfusion in acute trauma: Less plasma, greater precision
Radovan Dinić, Almira Šabani, Biljana Životić, Neda Horvacki, Nenad Mladenović, Jasmina Grujić Abstract
Background and Objectives
Effective transfusion management is essential in trauma patients with active bleeding. In this study, we aimed to evaluate the association between point‐of‐care rotational thromboelastometry (ROTEM)‐guided management, blood‐component utilization, and clinical outcomes.
Materials and Methods
We conducted a retrospective comparative cohort study of 200 trauma patients with active bleeding admitted between October 2023 and March 2025. One‐hundred patients received ROTEM‐guided management and 100 were managed using conventional coagulation tests. Blood‐component utilization during the first 24 h and clinical outcomes were analyzed using multivariable models adjusted for relevant baseline variables.
Results
ROTEM‐guided management was associated with lower fresh frozen plasma utilization (adjusted incidence rate ratio [aIRR] 0.36, 95% confidence interval [CI]: 0.24–0.55), higher cryoprecipitate utilization (aIRR 1.92, 95% CI: 1.40–2.66), and shorter intensive care unit (ICU) stay. Adjusted red blood cell (RBC) and platelet utilization did not differ between groups. Maximum clot firmness in the fibrin‐based thromboelastometry assay correlated strongly with fibrinogen concentration, and clot formation time in the extrinsically activated thromboelastometry assay correlated inversely with platelet count. Differences in transfusion‐related complications and in‐hospital mortality were not statistically significant.
Conclusion
ROTEM‐guided management was associated with lower plasma utilization, higher cryoprecipitate utilization, and shorter ICU stay. Given the retrospective, non‐randomized design and low RBC exposure, these findings should not be interpreted as evidence that ROTEM reduced bleeding severity or RBC requirements, particularly in massive‐transfusion populations. Prospective studies in trauma patients with massive hemorrhage are required to evaluate the utility of ROTEM in guiding specific hemostatic blood‐product transfusions.