Major haemorrhage is an important cause of morbidity and mortality, affecting up to 40% of all trauma patients and 10% of cardiac surgery patients. Blood loss is one of the main causes of morbidity following liver transplantation and is one of the most common causes of death worldwide in women at the time of delivery. Diagnosis of major bleeding is difficult and is often made using clinical measures (e.g. rising heart rate, falling blood pressure) but these measures can be insensitive, particularly in younger patients in whom blood loss can be masked and haemodynamic stability preserved or in elderly patients on cardiovascular modulating medication. Detection and correction of coagulopathy is therefore an important aspect of management of severe haemorrhage. Viscoelastic haemostatic assays (VHA) are increasingly being used during the management of major bleeding. Current NICE guidance recommends VHA use during cardiac surgery, but not for obstetric or trauma haemorrhage. This BSH guideline recognises the limited available evidence but, within these constraints, aims to provide pragmatic and practical advice to practising clinicians as to how to interpret and use VHA results during the management of major bleeding in four common scenarios: obstetric haemorrhage, liver disease, cardiac surgery and trauma haemorrhage.

Declaration of Interests

The BSH paid the expenses incurred during the writing of this guidance. None of the authors had conflicts of interest to declare. All authors have made a declaration of interests to the BSH and Task Force Chairs which may be viewed on request.