Viscoelastic hemostasis analyses (VHA) are a complement in the evaluation of hemostasis in patients with major bleeding. The analysis measures viscoelastic changes in whole blood and the results give an overview of several components of hemostasis. VHA can be used to optimize fibrinogen levels, platelet and plasma substitution. The main clinical evidence supporting this strategy is in trauma, obstetric bleeding, heart and liver surgery, where algorithms based on VHA results facilitate individualized therapy. VHA measurement is of limited value to exclude treatment with anticoagulants and platelet inhibitors. Quality control aspects are also more cumbersome since whole blood with limited sustainability is used. Newer, more automated versions of the instruments have increased the reproducibility. The main advantage of VHA is the fast turn-around time and their role in guiding treatment in an emergency situation with bleeding.