Point-of-care viscoelastic testing

Hemostasis Assessment in Neonates: Evaluation of Viscoelastic Properties of Blood Clots

“…A significant correlation was found between FVIII:C, TEG R-time, and aPTT. At 24 hours, the TEG parameters were subtherapeutic despite the median FVIII:C of 13.0 IU/dL 1 and lost sensitivity at 48 hours. 35 In another study, Aghighi et al 36 demonstrated that measurement of maximum velocity parameters by ROTEM had a 92% sensitivity and 95% specificity for diagnosing hemophilia; these findings correlated strongly with factor VIII levels.…”

“…Blood clotting leads to the development of the TEG/ROTEM trace; the interpretations are similar, but not identical, to other different and non-interchangeable reference range parameters. 1 Several newer cartridge-based devices have improved the viscoelastic assessment as these do not need controlled pipetting, which is subject to interuser modifications and consequent errors. One of these is the viscoelastic coagulation monitor (VCM) device (VCM TM , Entegrion, Inc., Durham, North Carolina, USA), which provides an analysis of the coagulation state in approximately 1 hour with 300 μL of a fresh, whole blood sample.…”

“…In the absence of these data, we are not able to obtain a useful panoramic view of the entire hemostatic system. 1 These measurements are particularly important in infants as the hemostatic function is a dynamic system that undergoes quantitative/qualitative changes during development and postnatal age, and also gets disrupted during critical illness. Clearly, conventional coagulation tests may not be adequate to identify inherited/acquired coagulation disorders of various degrees of severity, and to guide transfusions frequently needed in premature/ critically ill neonates.…”

The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?

“…Parameters assessed include time to clot formation (R/CT time), speed of clot formation (alpha angle), clot strength (MA [maximum amplitude] or MCF [maximum clot firmness]) and clot disintegration or lysis (LY30 and LY60, or CLT) [ 9 ]. Each of these components act as activity markers of plasma protein hemostasis function, platelet activity, fibrinogen and fibrinolysis, respectively [ 9 , 10 ]. The main parameters assessed by TEG ® and ROTEM ® systems, and their significance, are listed below and summarized in Table 1 .…”

Ruthenium Antivenom Inhibits the Defibrinogenating Activity of Crotalus adamanteus Venom in Rabbits

“…While one of the first utilizations of thrombelastography/thromboelastometry to assess coagulopathy after envenomation was reported thirty-four years ago [ 14 ], the vast majority of clinical and laboratory reports in human and veterinary settings have been published in the last decade, with a few examples cited for the interested reader [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Facile modifications of thrombelastographic methodologies that allow the assessment of changes in fibrinogen include using either antibodies to block platelet receptor glycoprotein IIb/IIIa to prevent attachment that forms fibrin polymers in whole blood [ 35 ], inhibiting the degranulation and formation of the glycoprotein IIb/IIIa by inhibiting microtubular activity with cytochalasin D [ 34 , 35 , 36 ], or by separating plasma in sodium citrate-anticoagulated whole blood [ 33 ]. With the contribution of platelets removed in terms of attachment to fibrin polymers, contraction, and release of factor XIII known to further enhance the speed of clot growth and strength [ 37 ], the coagulation kinetics observed involve only the various coagulation pathway proteins, with fibrinogen playing a critical role in final thrombus strength [ 38 ].…”