Viscoelastic Studies: Effective Tools for Trauma and Surgical Resuscitation Efforts

Abstract

Trauma-induced coagulopathy (TIC) is an abrupt disruption of all hemostatic components of coagulation resulting from severe tissue injury and hypoperfusion. The effective management of TIC has remained elusive to clinicians using traditional laboratory methods, challenging efforts to improve outcomes related to uncontrolled bleeding. Recent initiatives have aimed to reduce TIC-associated morbidity and mortality, further invoking trauma experts to explore innovative modalities in the field of viscoelastic studies, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM). These tests are able to guide proper blood product administration more effectively during trauma and surgical resuscitation compared with conventional laboratory tests. Although TEG and ROTEM are similar tests, inherent differences in their features produce variation in output results. This article calls on the perioperative clinician to evaluate TEG and ROTEM tests and consider their implementation based on the benefits of their application to clinical practice.

Establishment of normal reference intervals in dogs using a viscoelastic point‐of‐care coagulation monitor and its comparison with thromboelastography

“…The VCM Vet machine generates values that are similar to other viscoelastic devices. As previously demonstrated, viscoelastic assays, while similar for the generated data, are not directly comparable due to differences in methodologies and the various activators used 9 . Activators, such as TF, kaolin, or celite, expedite the assay by accelerating secondary hemostasis, as well as diminishing viscoelastic test variabilities.…”

“…The VCM Vet analyzer could serve as a bedside test for the global assessment of coagulation in veterinary patients presenting with an array of hemostatic abnormalities. In human patients, one of the largest uses of viscoelastic tests is hemostasis monitoring in hypocoagulable patients requiring blood product transfusions secondary to trauma or invasive surgical procedures 9,10,11,12 . Viscoelastic tests in these patient populations have resulted in the use of fewer blood products and associated adverse events.…”

The application of thromboelastography in risk stratification for selective thromboembolism prophylaxis after total joint arthroplasty in Chinese: a randomized controlled trial

“…TEG provides a direct overview of the clotting process, from initial thrombin generation to formation of fibrin strands and fibrinolysis, which means that it is real time and can instantly reflect thrombophilia (16,22). Moreover, it can sensitively identify patients with postinjury hypercoagulability (23)(24)(25). However, the use of TEG to assess the risk of VTE and then to guide the regimen for pharmacological prophylaxis has not yet been described.…”

Neurosurgical applications of viscoelastic hemostatic assays

“…Both assays determine a graphical output that represents clot formation and dissolution that is generated by the translation of torque along a torsion pin during thrombogenesis and fibrinolysis. 52 The primary difference between the two concerns the movement of the cup, which holds the whole blood sample, and the sensor pin, which measures clot strength. Specifically, with TEG, the cup rotates while the pin is suspended freely in the cup, whereas with ROTEM these dynamics are reversed.…”

“…52 VHAs allow for rapid, point-of-care testing and identify all phases of hemostasis, from initial fibrin formation to clot lysis. VHAs provide a real-time analysis of hemostasis with information on the kinetics of clot formation and clot stability from the occurrence of the initial thrombin burst to fibrinolysis.…”