Neurosurgical applications of viscoelastic hemostatic assays

Abstract

<jats:p>Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient’s exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years. Furthermore, thromboembolic complications such as deep venous thrombosis, pulmonary embolism, and myocardial infarction are common complications of major surgery. These trends, in conjunction with a growing understanding of the hemostatic process and its contribution to the pathophysiology of disease, stress the importance of the complete evaluation of a patient’s hemostatic profile in guiding management decisions. Viscoelastic hemostatic assays (VHAs), such as thromboelastography and rotational thromboelastometry, are global assessments of coagulation that account for the cellular and plasma components of coagulation. This FDA-approved technology has been available for decades and has been widely used in cardiac surgery and liver transplantation. Although VHAs were cumbersome in the past, advances in software and design have made them more accurate, reliable, and accessible to the neurosurgeon. VHAs have demonstrated utility in guiding intraoperative blood product transfusion, identifying coagulopathy in trauma, and managing postoperative thromboprophylaxis. The first half of this review aims to evaluate and assess VHAs, while the latter half seeks to appraise the evidence supporting their use in neurosurgical populations.</jats:p>

WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours

“…Moreover, they can be particularly useful in patients taking novel oral anticoagulants (NOACs) and in the evaluation of PLT dysfunction induced by trauma and/or drugs [10]. In light of the above, these tests may be useful in TBI polytrauma patients [50].…”

Improving decision making through presentation of viscoelastic tests as a 3D animated blood clot: the Visual Clot

“…The use of viscoelastic testing is recommended in European guidelines for managing trauma and severe perioperative bleeding, as it helps to reduce transfusion of allogeneic blood products [1,3]. Its benefits have been shown not only in trauma induced coagulopathy [3,4], but also in obstetric haemorrhage [5,6], cardiac surgery [7,8], transplantation [9], burn surgery [10], and neurosurgery [11]. Further, viscoelastic tests play a role in the diagnosis and treatment adjustment of haematological disorders like haemophilia, multiple myeloma or inherited afibrinogenemia [12][13][14][15].…”

Physicians’ Perceptions of a Situation Awareness–Oriented Visualization Technology for Viscoelastic Blood Coagulation Management (Visual Clot): Mixed Methods Study

“…Furthermore, viscoelastic point-of-care coagulation testing reduces the transfusion of allogeneic blood products in trauma [ 2 , 10 ]. Previous studies also showed the benefits of its use in cardiac [ 1 , 11 , 12 ], transplant [ 13 ], neuro [ 14 ], and pediatric surgery [ 5 ].…”