Bedside Snapshot

Normal (Adult): Device-specific. No universal viscoelastic range. Use the printed reference for your TEG or ROTEM device and cartridge
Critical Values: Fibrinogen ≤1.5 g/L (≤150 mg/dL) or a functional fibrinogen deficit; LY30 ≥3% (hyperfibrinolysis). No universal numeric critical value
High Suggests: Prolonged R or CT: factor deficiency or anticoagulant (LMWH, DOAC)
LY30 ≥3%: hyperfibrinolysis
Low Suggests: Low MA, MCF or FIBTEM: fibrinogen or platelet deficit. Low LY30 (≤0.8%) is shutdown and is not reassuring
Act Now If: Major bleeding: tranexamic acid 1 g IV over 10 min, then 1 g over 8 h, within 3 h of injury, without waiting for the test; give calcium; send viscoelastic and fibrinogen testing
Watch Out For: Citrated blood and low calcium make tracings look falsely hypercoagulable. Treat by the trend and repeat hourly, not by one tracing

Reference & Critical Ranges

Device-specific ranges: There is no universal normal range for viscoelastic results. Each TEG or ROTEM device, cartridge and reagent sets its own intervals. Read the range printed on your report. The thresholds below are the action levels from the cited sources.

Test parameters and units

Measure	TEG name	ROTEM name	Units and what it reflects
Clot start	R (reaction time)	CT (clotting time)	min; time to first clot formation. Prolonged in factor deficiency or anticoagulation
Clot build speed	K and α angle	CFT (clot formation time) and α	min and degrees; how fast the clot strengthens
Maximum strength	MA (maximum amplitude)	MCF (maximum clot firmness)	mm; overall clot strength, driven by fibrinogen and platelets
Fibrinogen contribution	Device fibrinogen assay	FIBTEM A5 (amplitude at 5 min)	mm; fibrin-based clot strength used in fibrinogen decisions
Fibrinolysis	LY30 (% lysis 30 min after MA)	CL30 (clot lysis at 30 min)	%; the share of clot lost 30 min after peak strength

Severity and action thresholds

Level	Threshold	Source	What it means
Critical	Fibrinogen ≤1.5 g/L (≤150 mg/dL) or a viscoelastic functional fibrinogen deficit	2023 European trauma guideline	Major bleeding with hypofibrinogenemia: give fibrinogen concentrate or cryoprecipitate
Critical	LY30 ≥3% (hyperfibrinolysis)	Adult and pediatric admission cohorts (rapid TEG)	Lysis at the level linked with a doubling of mortality; treat as active fibrinolysis in bleeding. The cut-off was derived on rapid TEG; no validated ROTEM CL30 equivalent is given here
Physiologic lysis	LY30 0.9–2.9%	Adult admission cohort	Lysis within the range seen in the adult admission cohort
Fibrinolysis shutdown	LY30 ≤0.8% (2016 cohort); <0.9% (2023 guideline)	Adult admission cohort; guideline	Little lysis; linked with higher mortality, not with safety
Factor and plasma trigger	PT or aPTT >1.5 times normal, or viscoelastic clot-time prolongation	2023 European trauma guideline	Plasma or factor concentrate guidance in the guideline's plasma-based pathway
Algorithm trigger	PTr >1.2; fibrinogen <2 g/L; platelets <100 ×10⁹/L	Pragmatic algorithm cited in the 2023 guideline	Thresholds from a six-centre algorithm study; use only inside an approved local algorithm
Platelet guidance (bleeding trauma)	Keep platelets above 50 ×10⁹/L with ongoing bleeding; above 100 ×10⁹/L with TBI	2023 European trauma guideline, recommendation 30 (Grade 2C)	A suggested transfusion target in the guideline, not a diagnostic cut-off; the 100 ×10⁹/L algorithm trigger above is a local-protocol value

Critical values: Viscoelastic testing has no universal numeric critical value. Two thresholds drive action: fibrinogen ≤1.5 g/L, or a functional fibrinogen deficit on the tracing, and LY30 ≥3%, which means hyperfibrinolysis. Your local algorithm sets everything else.

Conversion: Fibrinogen: 1 g/L is 100 mg/dL, so 1.5 g/L is 150 mg/dL. Platelets ×10⁹/L is the same as ×10³/µL.

Causes of Abnormal Results

Prolonged clot start (high R or CT)

Mechanism	Common causes	Bedside clue
Coagulation factor deficiency	Factor loss in major bleeding; the 2023 guideline ties a prolonged EXTEM clotting time to factor deficiency	EXTEM CT still prolonged after fibrinogen is above 1.5 g/L
Anticoagulant effect	Low-molecular-weight heparin, vitamin K antagonists, direct oral anticoagulants (DOAC)	Known anticoagulant exposure; viscoelastic tests detect LMWH and NOAC effect better than lab tests

Low clot strength (low MA, MCF or FIBTEM A5)

Mechanism	Common causes	Bedside clue
Functional fibrinogen deficit	Low fibrinogen is the expected early pattern in traumatic coagulopathy	Low FIBTEM amplitude or MCF; fibrinogen at or below 1.5 g/L
Platelet deficit or dysfunction	Low platelet count (local algorithm trigger 100 ×10⁹/L; guideline bleeding target 50 ×10⁹/L, or 100 with TBI); antiplatelet drugs	Low MA with a normal fibrinogen contribution; point-of-care platelet tests are not interchangeable

Early pattern: Early in trauma, fibrinogen drops while thrombin generation holds or even climbs. So a low fibrinogen result does not prove the clot is failing on its own.

High lysis: hyperfibrinolysis (LY30 ≥3%)

Mechanism	Common causes	Bedside clue
Fibrinolytic activation after injury	Severe trauma with shock; the phenotype is the most lethal one in trauma, and viscoelastic testing is highly specific for it	Tracing narrows steeply after maximum strength; bleeding out of proportion to the clot
Shock and dilution	Higher admission base deficit and more prehospital crystalloid (1.5 vs 0.5 L in one 2012 cohort)	Admission hyperfibrinolysis tracks with prehospital crystalloid volume

Thromboelastography tracing in primary fibrinolysis: clot amplitude narrows rapidly after peak strength — **Figure 1:** Primary fibrinolysis: the tracing narrows steeply after maximum clot strength, the pattern behind a high LY30. Illustrative tracing, not patient data. Source: Wikimedia Commons, Mikael Häggström, CC0

Mortality: Of the three phenotypes in the adult admission cohort, hyperfibrinolysis was the deadliest, at 34%. In children with an admission LY30 ≥3%, mortality climbed from 6% to 14%.

Shutdown: low lysis (LY30 ≤0.8% or <0.9%)

Shutdown was the most common admission pattern in the adult cohort, at 46%. It also carried higher mortality than physiologic lysis (adjusted odds ratio 1.6). Don't read a low LY30 as good news. It is a warning sign. Treatment decisions do not rest on that number alone (see Interpretation).

Interpretation & Bedside Approach

Step-by-step approach

Is it real? Check the sample: citrated whole blood, run as the device requires. Transfused plasma and platelets carry citrate too, and that can make a tracing look falsely hypercoagulable unless calcium is replaced.
How sick is the patient? Shock, ongoing bleeding and surgical source control set the urgency. Viscoelastic testing guides the coagulation part of resuscitation. It does not replace control of the bleeding.
Which part of the tracing is abnormal? Read clot start (R or CT), clot strength (MA or MCF), the fibrinogen contribution (FIBTEM A5), and lysis (LY30) separately. Each points to a different product.
Trend beats a single value. While bleeding is active, repeat viscoelastic testing at least hourly and after each major intervention.
Match the defect to the product. Low fibrinogen: fibrinogen concentrate or cryoprecipitate. Prolonged CT after fibrinogen is above 1.5 g/L: prothrombin complex concentrate. High lysis: tranexamic acid (already given per protocol). Low platelets: platelets per algorithm.
Reassess and escalate. Re-test after each product. If the bleeding continues, escalate to surgery, interventional radiology or the massive transfusion pathway.

Decision patterns

Pattern	Suggests	Response in the cited guidance
Low FIBTEM or MCF	Functional fibrinogen deficit	Fibrinogen 3–4 g, or 15–20 single-donor cryoprecipitate units; repeat by viscoelastic and fibrinogen level
EXTEM CT prolonged after fibrinogen >1.5 g/L	Factor deficiency	Prothrombin complex concentrate; avoid overly liberal use because of delayed thrombotic risk
LY30 ≥3%	Hyperfibrinolysis	Tranexamic acid; it should not wait for the viscoelastic result
LY30 low (shutdown)	Low lysis	Do not withhold tranexamic acid on this result alone
Prolonged R or CT, DOAC exposure	Anticoagulant effect, possibly mixed with trauma coagulopathy	Confirm with anti-Xa or PT; viscoelastic cannot separate the two when CT is prolonged

Do not use viscoelastic testing to opt out of early empiric treatment. The 2026 review does not back waiting on the test. Give tranexamic acid and early fibrinogen per protocol while it runs.

Management Priorities

Emergency: Major bleeding with suspected coagulopathy

Tranexamic acid: Don't wait on the viscoelastic result. Give 1 g IV/IO over 10 min, then 1 g over 8 h, starting within 3 h of injury.
Calcium: Calcium chloride is the preferred agent. Start early, and keep replacing it through massive transfusion.
Balanced products: Aim for a 1:1:1 ratio of whole blood or components, per the 2026 TSACO review and PROPPR. ESA 2023 recommends a fibrinogen-based strategy, or a plasma:RBC ratio of at least 1:2 (Grade 1C). Follow the local massive transfusion protocol.
Viscoelastic-directed: Fibrinogen comes first. Use prothrombin complex concentrate only if EXTEM CT stays prolonged once fibrinogen is above 1.5 g/L.
Monitor and repeat: Test again at least hourly while bleeding is active, and after each major product.

Medications

Drug	Adult dose	Pediatric dose (max)	Onset / key notes
Tranexamic acid	1 g IV/IO over 10 min, then 1 g IV over 8 h (2 g total) Start within 3 h of injury	Off-label; per protocol: 15 mg/kg IV/IO over 10–20 min (max 1 g), then 2 mg/kg/hr (max 1 g over 8 h)	Immediate. Do not wait for viscoelastic results; give as soon as possible. Pediatric dose matches the E3 TXA page; not in the 2023 guideline
Fibrinogen concentrate or cryoprecipitate	3–4 g IV initial (equal to 15–20 single-donor cryoprecipitate units); repeat by viscoelastic and fibrinogen level	Weight-based; see the fibrinogen page	Start for Clauss fibrinogen ≤1.5 g/L or a viscoelastic functional deficit. Do not treat empirically above that level
4-factor PCC, vitamin K antagonist reversal	25 units/kg if INR 2 to under 4 (max 2,500 units); 35 units/kg if INR 4–6 (max 3,500); 50 units/kg if INR above 6 (max 5,000). Give with vitamin K Label dose caps (Kcentra); dosing by actual weight up to 100 kg	Not established in children: specialist or medical-control use only	Boxed warning: arterial and venous thromboembolic complications. Use for life-threatening bleeding; monitor for thrombosis during recovery; consider thromboprophylaxis once bleeding is controlled
4-factor PCC, trauma coagulopathy without a vitamin K antagonist (off-label)	Off-label; dose per local protocol. ESA 2023 recommendation 34 suggests 25–50 units/kg for factor Xa inhibitor effect when andexanet is unavailable (Grade 2C), with an initial dose of 25 units/kg Only after fibrinogen is above 1.5 g/L and EXTEM CT stays prolonged (viscoelastic-directed)	Not established in children: specialist or medical-control use only	Same boxed thromboembolic warning. Avoid overly liberal use; ESA 2023 notes delayed thrombotic risk
Vitamin K1 (phytonadione)	5–10 mg IV, given with PCC for vitamin K antagonist reversal in bleeding Slow infusion, not faster than 1 mg/min	Per pediatric protocol	Given with PCC for vitamin K antagonist reversal (2023 guideline, Grade 1A). Boxed warning: severe and fatal hypersensitivity or anaphylaxis with IV or IM use; the label prefers subcutaneous use when IV is not essential
Plasma	Typical local-protocol volume about 15 mL/kg (not a guideline dose). ESA 2023 gives no mL/kg figure; guide by PT or aPTT above 1.5 times normal or viscoelastic clot-time prolongation (recommendation 27)	Typical local-protocol range 10–15 mL/kg (actual weight); not a guideline dose	Further plasma by lab or viscoelastic evidence of factor deficiency, not by fixed ratio alone
Platelets	Initial dose 4–8 single units or 1 apheresis pack (ESA 2023, Grade 2B). ESA trigger: keep count above 50 ×10⁹/L with ongoing bleeding and above 100 ×10⁹/L with TBI (Grade 2C). A local algorithm may use 100 ×10⁹/L	5–10 mL/kg or 1 unit per 10 kg	ESA 2023 (Grade 1C): avoid routine platelet transfusion in bleeding patients on antiplatelet drugs. Point-of-care platelet function tests are not interchangeable
Calcium chloride	1 g IV (10 mL of 10%) given slowly over about 10 min, repeat per ionized calcium	Weight-based per protocol; not set here	Vesicant: extravasation can cause tissue necrosis. Give into a central or deep vein, not as a bolus (label maximum 1 mL/min). Do not run in the same line as citrated blood products. 10 mL of 10% gives 270 mg elemental calcium; 10 mL of 10% calcium gluconate gives 90 mg

Definitive care & disposition

Dabigatran bleeding: Give idarucizumab 5 g IV for life-threatening bleeding. Repeat coagulation tests, viscoelastic included, within 5–10 min.
Surgery and intervention: Viscoelastic results steer coagulation therapy. Source control (surgery, interventional radiology) decides the bleed.
ICU: Patients who are still bleeding need repeat viscoelastic testing for as long as the bleeding goes on.
ECMO: Anticoagulation and bleeding on ECMO follow the ECMO page and the local protocol. This page sets no ECMO targets.

Doses are typical references. Follow local protocols, medical direction and institutional policy.

Field & Transport Considerations

Point-of-care testing

Point-of-care viscoelastic testing now comes in cartridge-based machines: the TEG 6s (FDA approved in 2019) and the ROTEM sigma (FDA approved in 2022). The screen can update live in the trauma bay, the OR or the ICU. A few prehospital systems feed viscoelastic data into in-field decisions. But a TEG result and a ROTEM result are not interchangeable.

Before and during interfacility transport

Tranexamic acid first: Give it as early as possible, en route if feasible and within 3 h of injury. Don't hold it for a viscoelastic result.
Calcium: Start early and keep it going through transfusion. Citrated products drop ionized calcium.
Repeat the test: If the receiving site has a device, repeat viscoelastic testing at least hourly while bleeding continues.

Setting	Consideration
Prehospital (EMS)	Tranexamic acid and early calcium per protocol; viscoelastic data only where the system provides it
Interfacility transport (CCT)	Carry the last viscoelastic result, the time of each product, and the calcium dose
Receiving ICU or OR	Repeat viscoelastic testing; fibrinogen and PCC per the tracing; plasma and platelets per algorithm

Timing & Kinetics

Parameter	Value	Clinical implication
Tranexamic acid window	Within 3 h of injury	The guideline's Grade 1A window; earlier is better, and the drug is not delayed for testing
Tranexamic acid infusion	1 g over 10 min, then 1 g over 8 h	The 8-hour infusion continues after handover; record the start time
LY30 timing	Amplitude loss measured 30 min after maximum amplitude	A result needs the full test run; it describes lysis after peak clot strength, not before it
Repeat viscoelastic testing	At least hourly during active bleeding	Track the trend; one tracing is not a transfusion order
Prehospital tranexamic acid	Not reliably detected by admission viscoelastic testing	An admission tracing cannot confirm TXA given before arrival; check the prehospital record

Special Populations

Population	What changes	Clinical implication
Children & adolescents	Admission hyperfibrinolysis (LY30 ≥3%) was present in 24% of severely injured children aged 17 or younger in the 2015 cohort; earlier adult studies cited about 9%	Hyperfibrinolysis carried a mortality rise from 6% to 14%. Pediatric TXA dosing is off-label; follow the pediatric protocol and medical direction
Pregnancy (postpartum hemorrhage)	Fibrinogen rises at term; OBS2 (55 women randomized, underpowered) treated FIBTEM A5 ≤15 mm, and subgroup data suggest replacement may not be needed above 12 mm or a Clauss level above 2 g/L	In the randomized trial, fibrinogen concentrate did not significantly reduce units transfused (the primary outcome). The trial was small, and benefit below 12 mm or 2 g/L was not excluded. Follow the obstetric hemorrhage protocol; do not withhold fibrinogen for a low level during ongoing bleeding
Older adults	No age-specific viscoelastic thresholds in the sources checked	Use the same device algorithm and clinical context; this is not an age-based adjustment
Cardiac surgery	Viscoelastic-guided algorithms lowered plasma and platelet transfusion in pooled trials	The 2026 Cochrane review: TEG/ROTEM-guided algorithms may reduce mortality (RR 0.76, 95% CI 0.63–0.92), with very low certainty and very uncertain evidence; plasma RR 0.52, platelets RR 0.69. Evidence is mostly from elective cardiac surgery
Anticoagulated patients	DOAC and LMWH prolong clotting; apixaban has little effect on CT even at high levels	A prolonged CT cannot separate a DOAC from trauma coagulopathy; check anti-Xa or PT as well

Evidence limit: Most viscoelastic trials are small. Many show no mortality benefit. Trauma and obstetric outcomes are mixed, so use the algorithm your institution has adopted.

Interfering Factors & Pitfalls

Collection & handling

Factor	Effect	Why	Avoid / fix
Citrated blood or citrated products	False hypercoagulable tracing	Citrate removes calcium; artifact compounds with repeated transfusion	Replace calcium early and during massive transfusion; repeat on the trend, not one tracing
Prehospital crystalloid	Associated with admission hyperfibrinolysis	Hemodilution and shock; each extra litre was linked with about 15% higher odds in one cohort	Follow a restrictive crystalloid strategy per protocol

Medications & supplements

Factor	Effect	Why	Avoid / fix
DOAC (apixaban, rivaroxaban)	↑ CT, variable	Mixes with trauma coagulopathy; apixaban has little effect on CT at high levels	Anti-Xa or PT alongside the test; ROTEM is less affected by low DOAC levels
Dabigatran	Reversal needed	Thrombin inhibition	Idarucizumab 5 g IV; repeat testing within 5–10 min
Antiplatelet drugs	Platelet dysfunction	Point-of-care platelet tests do not agree; aspirin detection is better than ADP detection	Avoid routine point-of-care platelet function testing in trauma
Heparin (including line flushes)	↑ R or CT	Heparin prolongs clot start on standard activators; common in cardiac surgery and from heparinised lines or sample contamination	Use a heparinase-containing assay (for example, ROTEM HEPTEM) to separate heparin effect from factor deficiency

Assay & device-specific

Devices: TEG and ROTEM values don't translate directly. Use the reference and cut-offs for the device in front of you.
Phenotype definitions: Fibrinolysis cut-offs vary between systems and studies. A 7.5% LY30 cut-off came from a 2012 rapid TEG cohort, while later cohorts used 3%. The 3% threshold came from rapid TEG. This page gives no validated ROTEM CL30 equivalent.
Prehospital TXA: Admission viscoelastic testing lacks the sensitivity to show TXA given before arrival.

Common misinterpretations

"Low LY30 means safe." It doesn't. Shutdown was linked with higher mortality than physiologic lysis.
"Wait for the test before TXA." The guideline says to give TXA without waiting.
"Low FIBTEM always needs fibrinogen." In obstetric hemorrhage, the evidence is one small, underpowered trial (OBS2, 55 women randomized). It found no benefit at a 15 mm trigger. A low level during ongoing bleeding is still managed per protocol.

Physiology & Test Basics

What it measures

One small sample of whole citrated blood gives you clot formation and breakdown as a single continuous tracing. Fibrin, platelets and fibrinolysis show up together. PT/INR, aPTT and fibrinogen each measure one piece of plasma clotting. This page covers the point-of-care TEG and ROTEM tests used to guide bleeding treatment. For the individual lab tests, see the coagulation panel pages.

Physiology & regulation

Clotting starts with thrombin generation. Fibrin strength depends on fibrinogen and platelets.
Fibrinolysis breaks fibrin down. Hyperfibrinolysis is too much breakdown after injury. Shutdown means very little breakdown.
Traumatic coagulopathy is typically low fibrinogen with variable fibrinolysis. Thrombin generation holds up early on.

How it is measured

Each test uses about 300 µL of citrated whole blood, run at the bedside or in the lab. What starts the clot matters. TEG uses kaolin. ROTEM's INTEM assay uses ellagic acid, and its EXTEM assay uses tissue factor. Each activator changes how sensitive the test is to anticoagulants and antiplatelet drugs. Follow the collection tube and fill instructions in the device manual.

Annotated viscoelastic trace marking R, K, alpha angle, maximum amplitude and amplitude at 30 minutes — **Figure 2:** Illustrative TEG tracing of standard parameters: R (clot start) and K (time from clot start to an amplitude of 20 mm, marked on the trace), alpha, MA (maximum amplitude) and A30 (amplitude 30 minutes after MA, used for LY30). Not patient data. Source: Wikimedia Commons, Mikael Häggström, CC0

Why it matters

Conventional tests cover only part of the process, and they are often slow (2026 review). That is why viscoelastic testing can guide fibrinogen, plasma, platelet and PCC decisions in near real time. The trauma evidence is mixed. The randomized ITACTIC trial found no overall difference in outcome. A 2026 Cochrane review finds that TEG/ROTEM-guided transfusion may reduce mortality, but with very low certainty. Most of that evidence comes from elective cardiac surgery.

Clinical Pearls

Calcium is part of the test: Transfused plasma and platelets carry citrate too. Tracings then look more clotted than they are. Keep ionized calcium replaced through massive transfusion.

Read the trend: One value tells you little. Repeat the test at least hourly during active bleeding, and log the time of each product. The change after treatment matters more than any single number.

Shutdown is not safety: A low LY30 went with higher mortality than physiologic lysis. It doesn't cancel tranexamic acid given per protocol.

Crystalloid matters: In a 2012 adult cohort, each extra litre of prehospital crystalloid went with about 15% higher odds of hyperfibrinolysis. That cohort used rapid TEG and defined hyperfibrinolysis as LY30 above 7.5%. Follow a restrictive fluid strategy per protocol.

Obstetric fibrinogen: In OBS2 (55 women randomized, underpowered), fibrinogen concentrate triggered at FIBTEM A5 of 15 mm did not reduce blood use. Subgroup data suggest it is unnecessary above 12 mm or Clauss above 2 g/L. Benefit below those levels was not ruled out. Follow the local obstetric hemorrhage protocol. Do not withhold fibrinogen for a low level during ongoing bleeding.

DOAC patients: A prolonged clotting time can't tell a DOAC from trauma coagulopathy. Add anti-Xa or PT before you choose the reversal.

Transport: Hand over the last test result, when it was run, and every product given. Tranexamic acid and calcium shouldn't wait for the next tracing.

References

Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. https://doi.org/10.1186/s13054-023-04327-7
Brito AM, Schreiber MA. Precision hemostasis: how viscoelastic testing guides real-time decision-making in trauma. Trauma Surg Acute Care Open. 2026;11(Suppl 1):e002241. https://pmc.ncbi.nlm.nih.gov/articles/PMC13141058/ (doi:10.1136/tsaco-2026-002241)
Kvisselgaard AD, Wolthers SA, Wikkelsø AJ, et al. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2026;(5):CD007871. https://pubmed.ncbi.nlm.nih.gov/42145275/ (doi:10.1002/14651858.CD007871.pub4)
Baksaas-Aasen K, Gall LS, Stensballe J, et al. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med. 2021;47(1):49–59. https://doi.org/10.1007/s00134-020-06266-1
Collins PW, Cannings-John R, Bruynseels D, et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth. 2017;119(3):411–421. https://doi.org/10.1093/bja/aex181
Moore HB, Moore EE, Liras IN, Gonzalez E, et al. Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients. J Am Coll Surg. 2016;222(4):347–355. https://doi.org/10.1016/j.jamcollsurg.2016.01.006
Liras IN, Cotton BA, Cardenas JC, Harting MT. Prevalence and impact of admission hyperfibrinolysis in severely injured pediatric trauma patients. Surgery. 2015;158(3):812–818. https://doi.org/10.1016/j.surg.2015.05.004
Cotton BA, Harvin JA, Kostousouv V, Minei KM, et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg. 2012;73(2):365–370. https://doi.org/10.1097/TA.0b013e31825c1234

Last updated October 2026 Spotted something wrong? Report an error and include the page URL.

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Viscoelastic Testing (TEG / ROTEM)