Authors' objectives: To assess the effectiveness, safety and cost-effectiveness of VHA for the management of patients with bleeding in non cardiac surgery.

Authors' results and conclusions: In patients with trauma, VHA-guided therapy was effective in guiding transfusion, with fewer consumption of blood products, avoidance of allogenic transfusion & reduction of blood wastage, compared to CCT. No difference in hospital LOS or QOL, and its effectiveness in terms of mortality was inconclusive. In patients with liver transplant, VHA-guided therapy was effective in guiding transfusion with less consumption of blood products, increase avoidance of allogenic transfusion, reduce postoperative mortality despite no difference in ICU or hospital LOS. Limited evidence on VHA-guided therapy in patients with PPH. Following VHA, lower complications reported in patients with liver transplant: re-operation due to bleeding, re-transplantation, acute kidney injury, however more viral infection and neurological complication, The use of VHA was estimated to generate cost saving in patients with trauma.

Authors' recommendations: Based on the above review, VHA may be used to guide transfusion and hemostatic therapy in the management of patients with trauma, and in liver transplant patients. The VHA may also be used to guide transfusion and haemostatic therapy in patients with PPH. However, in view of limited evidence, outcome data is encouraged.

Authors' methods: Studies were identified by searching electronic databases. The following databases were searched through the Ovid interface: MEDLINE(R) In-process and other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to present. EBM Reviews-Cochrane Database of Systematic Reviews (2005 to March 2020), EBM Reviews-Cochrane Central Register of Controlled Trials (September 2021), EBM Reviews – Database of Abstracts of Review of Effects (3rd Quarter 2021), EBM Reviews-Health Technology Assessment (3rd Quarter 2021), EBM Reviews-NHS Economic Evaluation Database (3rd Quarter 2021). Parallel searches were run in PubMed. Appendix 3 showed the detailed search strategies. No limits were applied to the search. The last search was run on 30 September 2021. Additional articles were identified from reviewing the references of retrieved articles. Among the tools used to assess the risk of bias and methodological quality of the articles retrieved is the Cochrane risk of bias tool and Critical Appraisal Skills Programme (CASP) checklist. All full text articles were then graded based on guidelines from the US/Canadian Preventive Services Task Force.

Authors' identified further research: -

Project Status: Completed

Year Published: 2021

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/382

Requestor: Ministry of Health, decision-making committee

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)