Takes into account the SCTs -PT/INR, platelet count and serum fibrinogen levels to guide transfusion prior to high risk of bleeding invasive procedure. If INR ≤1.8, platelet count ≥50,000/mm3 and serum fibrinogen ≥120 mg/dL, no transfusion is indicated. Otherwise, if INR >1.8, FFP is transfused at 10 mL per kg of body weight; and/or if platelet count <50,000/mm3, 1 unit per 10 kg of body weight of platelets (up to 10 units) is transfused; and/or if serum fibrinogen <120 mg/dL, 1 unit per 10 kg of body weight of cryoprecipitate is transfused (up to 10 units).

The thromboelastometry-based transfusion protocol uses EXTEM and FIBTEM. No transfusion is necessary when CT-EXTEM is ≤80 s and A10-EXTEM is ≥40 mm. For patients in whom CT-EXTEM is >80 s, transfusion of 10 mL per kg of body weight of FFP will be performed. If the patient presents an A10-EXTEM <40 mm, the investigators will further evaluate the A10-FIBTEM. If A10-FIBTEM is ≥10 mm (indicating adequate fibrinogen function), platelet units (1 unit per 10 kg of body weight; maximum 10 units) will be transfused. Otherwise, if A10-FIBTEM is <10 mm (indicating fibrinogen deficiency), cryoprecipitate (1 unit per 10 kg of body weight; maximum 10 units) will be transfused.

Blood Products transfusion

This measure represents the percentage of patients within the study population who received at least one transfusion of any blood component during study period. It is calculated by dividing the number of patients who were administered one or more units of a blood product by the total number of eligible patients in the cohort, and multiplying by 100 to express the result as a percentage. Blood products include platelets, fresh frozen plasma, or cryoprecipitate.

The incidence of major bleeding within the first 24 h after high risk of bleeding invasive procedures. It quantifies early clinically significant hemorrhagic complications and is typically expressed as a percentage or rate.

For the purposes of this measure, major bleeding is defined according to standardized clinical criteria. Commonly applied definitions include adapted criteria from the International Society on Thrombosis and Haemostasis (ISTH) or similar consensus frameworks. A bleeding event is classified as major if it meets one or more of the following conditions: fatal bleeding, symptomatic bleeding in a critical area or organ (intracranial, intraspinal, intraocular, retroperitoneal, pericardial, or intramuscular with compartment syndrome), a decrease in hemoglobin of ≥2 g/dL (≥20 g/L) within 24 hours attributable to bleeding

, transfusion of ≥2 units of packed red blood cells due to acute blood loss, bleeding requiring urgent procedural or surgical intervention.

This measure represents the proportion of transfusion episodes that are complicated by an acute transfusion-related adverse event occurring during or within 24 hours after the administration of a blood component. It will be expressed as a percentage and it will be calculated by dividing the number of transfusion episodes complicated by at least one qualifying acute adverse event by the total number of transfusion episodes administered during the study period. An acute transfusion-related adverse event is defined as a new clinical sign or symptom occurring during transfusion or within 24 hours after completion, for which a causal relationship to the transfused blood component is suspected, probable, or definite. The investigators will evaluate transfusion-associated cardiac overload, acute hemolytic transfusion reactions, anaphylactic reactions, febrile non-hemolytic reactions and urticarial reactions.