© Journal of Thoracic Disease. All rights reserved. jtd.amegroups.com J Thorac Dis 2017;9(Suppl 4):S299-S308 Background Hemorrhage in the perioperative period is a significant cause of patient morbidity and mortality after major surgery (1,2). An estimated one-third of post-surgical bleeding is the result of non-surgical, medical coagulopathy (3). Coagulopathy further increases risk of bleeding complications and requires both timely diagnosis as well as correction (4). Perioperative coagulopathy is frequently multifactorial, including dilution of plasma volume with intravenous fluid or packed red blood cells (pRBC), consumption of coagulation factors from ongoing bleeding, administration of antithrombotic medications such as heparin or antiplatelet agents, or patient-specific conditions such as end-stage liver disease, or inherited factor deficiencies. The treatment for perioperative bleeding consists of the transfusion of blood products. Anemia is corrected by means of transfusion of pRBC and treatment may be guided by patient hemoglobin or hematocrit levels, clinical symptoms, or elected empirically in settings of active hemorrhage. The correction of coagulopathy entails primarily the use Review Article Viscoelastic testing inside and beyond the operating room

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