Less Is More for Bleeding Management Algorithms in Cardiac Surgery: A Network Meta-Analysis and Meta-Regression of Randomized Studies

Overall, viscoelastic test-based BMAs are superior to conventional strategies in limiting RBC transfusions in the presence of major bleeding; however, a restrictive strategy of procoagulant administration is superior to a liberal strategy in terms of RBC transfusion containment. Liberal BMAs are associated with a significantly higher use of procoagulants without any benefit in terms of RBC transfusions; therefore, in terms of cost/benefit ratio, restrictive BMAs should be preferred.