This case report examines the role of thromboelastography (TEG) in managing a 64-year-old hemodialysis patient with Factor V deficiency and platelet function disorders undergoing coronary artery bypass grafting. Despite a mild decrease in Factor V activity, preoperative transfusions corrected platelet dysfunction, allowing for successful surgery. Postoperative strategies were also TEG-guided, showcasing its utility in complex clinical scenarios.