Managing perioperative haemostasis starts with the diligently taken patient history. Unfortunately, classic global tests such as the PT and aPTT have no predictive value with regard to an acquired intra- or postoperative bleeding diathesis. However, new assays for preoperative risk stratification are in clinical development. An attribute of good perioperative haemostasis management is the early, multidisciplinary problem assessment. With a preoperatively existing anticoagulation or antiplatelet therapy, perioperative bridging therapy needs to be carefully planned as cardiovascular risk patients have an increased risk of morbidity and mortality when their current anticoagulative therapy is simply stopped. If a haemorrhagic diathesis is known, a specific therapy should be scheduled early preoperatively. When excessive intra- and postoperative bleeding occurs, point of care diagnostics can help to determine the underlying pathophysiology. A predefined validated algorithm reduces the need for blood products. To establish an evidence based approach for the use of blood components and other procoagulants in such a situation requires prospective clinical trials. The actual knowledge on the pathophysiology of such incidents (e. g. cross linking defects by use of colloids, dilutional effects of volume therapy, repeated use of FFP, of antifibrinolytics, frequency of unwanted effects) should also be considered.