Are Viscoelastometric Assays of Old Generation Ready for Disposal? Comment on Volod et al. Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. J. Clin. Med. 2022, 11, 860

Abstract

With the advent of new viscoelastometric hemostatic assay (VHA) devices, with ready-to-use cartridge reagents allowing for their use by people without special laboratory skills, the appreciation of the actual clinical value of VHAs in settings such as severe trauma, post-partum hemorrhage, cardiac surgery and liver transplantation still needs to be fully validated. While two of the newest versions remain based on a ‘cup and pin’ system (ROTEM® sigma, ClotPro®), two other new devices (TEG® 6s, Quantra®) rely on very different technologies: clotting blood is no longer in contact with the probe and challenged by oscillation of one of the components but explored with ultrasound exposure. A systematic literature search (including Sonoclot®) retrieved 20 observational studies (19 prospective). Most studies pointed to imperfect agreements, highlighting the non-interchangeability of devices. Only a few studies, often with a limited number of patients enrolled, used a clinical outcome. No study compared VHA results with conventional laboratory assays obtained through a rapid tests panel. Clinical evidence of the utility of the new VHAs largely remains to be proven through randomized clinical trials, with clinically relevant outcomes, and compared to rapid panel hemostasis testing. The availability of new, improved VHA devices provides an impetus and an opportunity to do so.

Multichannel Resonant Acoustic Rheometry System for Rapid and Efficient Quantification of Human Plasma Coagulation

“…The technique overcomes the limitations of both conventional PT and VHA techniques such as TEG or ROTEM 11,12 . A criticism of clinicallyavailable VHA methodologies is that they considerably deform the clot sample, as they use either a rotating cup and pin system (e.g., TEG 5000, ROTEM delta, and ROTEM sigma), vertical cup and pin system (e.g., Sonoclot), or vibration detection by light emitting diode (e.g., TEG 6s) [21][22][23] .…”

A single‐center, retrospective analysis to compare measurement of fibrinogen using the TEG6 analyzer to the Clauss measurement in children undergoing heart surgery

“…This innovative approach distinguishes TEG6s from other devices like ROTEM, which has essentially automated the existing technique. 9 The result is a compact TEG6s device suitable for pointof-care use, requiring smaller sample volume, offering real-time visual results, and enabling easier testing, thereby proving beneficial in pediatric settings. 1,6,10 As TEG6s gains popularity in pediatric settings, 10 it is essential to validate the accuracy of this newer device in the pediatric population, which possesses unique characteristics compared to adults.…”

“…The TEG6s employs a fundamentally different microfluidics‐based technology compared to traditional pin and cup thromboelastography, even though the underlying principles remain the same. This innovative approach distinguishes TEG6s from other devices like ROTEM, which has essentially automated the existing technique 9 . The result is a compact TEG6s device suitable for point‐of‐care use, requiring smaller sample volume, offering real‐time visual results, and enabling easier testing, thereby proving beneficial in pediatric settings 1,6,10 …”

Reply to Bareille et al. Are Viscoelastometric Assays of Old Generation Ready for Disposal? Comment on “Volod et al. Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. J. Clin. Med. 2022, 11, 860”

“…We are pleased to see that Bareille et al have written a Commentary: “Are viscoelastometric assays of old generation ready for disposal?” [ 1 ] in response to our paper published in the Special Edition of the Journal of Clinical Medicine by Volod et al [ 2 ].…”