Coagulation disorders in the perioperative setting are complex. Appropriate procoagulant therapy requires a reliable and timely coagulation monitoring tool. Thomboelastometry/thrombelastography used as a point-of-care monitoring (POC) method allows a rapid and accurate differential diagnosis of the underlying coagulation disorder. Thomboelastometry/thrombelastography-guided algorithms may support the coagulation management of patients with acute coagulopathic bleeding. It has been shown that thomboelastometry/ thrombelastography-guided coagulation therapy can reduce transfusion requirements and patients' exposure to allogeneic blood products. These methods may help avoid unnecessary transfusion of blood products and coagulation factors, decrease costs, shorten surgical procedures, and lower the frequency of reoperations. Limitations of POC testing such as handling mistakes by non-laboratory personnel may be overcome by ongoing quality control, adequate training, audits, and user meetings. Randomized controlled trials are required to establish evidence-based POC-guided transfusion algorithms. Copyright © 2010, Nederlandse Vereniging voor Intensive Care. All Rights Reserved.