Rotational thromboelastometry (ROTEM) curve and parameters. Curve and parameters apply to the INTEM (mild intrinsic coagulation activation) and EXTEM (mild extrinsic coagulation activation) assays. Our algorithm uses the EXTEM assay, which is largely heparin insensitive and can, therefore, be used on a heparinized patient. EXTEM is also insensitive to extracorporeal‐induced platelet dysfunction. Prolonged EXTEM‐CT indicates reduced coagulation factor levels, and low‐amplitude EXTEM‐A10 indicates impaired clot firmness due to low fibrinogen levels or low platelet count. To differentiate between low fibrinogen levels and low platelet count, the algorithm uses the FIBTEM assay (mild extrinsic coagulation activation in the presence of a thrombocyte inhibitor to measure only the fibrin part of the clot). A low‐amplitude FIBTEM‐A10 indicates low fibrinogen levels. A normal FIBTEM‐A10 in the presence of a low‐amplitude EXTEM‐A10 indicates low platelet count.