Haensig M, et al. - Given that significant bleeding represents a well-recognized complication following cardiac surgical procedures and is related to worse outcome, and point-of-care testing of the coagulation status is enabled by thrombelastometry (ROTEM- rotational thromboelastometry), therefore, researchers performed this randomized trial to assess the ROTEM-guided blood component therapy. Randomization to either a 4-chamber ROTEM-guided blood-component transfusion protocol or treatment guided by an algorithm based on standard coagulation testing (control) was done in case of significant postoperative bleeding (> 200 ml/h) after elective isolated or combined cardiac surgical procedures patients. According to the findings, the efficacy of a treatment algorithm based on “point-of-care” 4-chamber ROTEM appeared at least equivalent to that of standard therapy in case of postoperative bleeding after cardiac surgical procedures. Less bleeding and a marked decrease in expenses and long-term mortality may be achieved with ROTEM-guided treatment in patients with long cardiopulmonary bypass-times.