Viscoelastic testing: Critical appraisal of new methodologies and current literature

Abstract

United States Food and Drug Administration (FDA)‐approved viscoelastic testing (VET) methodologies have significantly changed in the last 10 years, with the availability of cartridge‐based VET. Some of these cartridge‐based methodologies use harmonic resonance‐based clot detection. While VET has always allowed for the evaluation of real‐time clot formation, cartridge‐based VET provides increased ease of use as well as greater portability and robustness of results in out‐of‐laboratory environments. Here we review the use of VET in a variety of clinical contexts, including cardiac surgery, trauma, liver transplant, obstetrics, and hypercoagulable states such as COVID‐19. As of now, high quality randomized trial evidence for new generation VET (TEG 6s, HemoSonics Quantra, ROTEM sigma) is limited. Nevertheless, the use of VET‐guided transfusion algorithms appears to result in reduced blood usage without worsening of patient outcomes. Future work comparing the new generation VET instruments and continuing to validate clinically important cut‐offs will help move the field of point‐of‐care coagulation monitoring forward and increase the quality of transfusion management in bleeding patients.

Hemostasis in Pre-Eclamptic Women and Their Offspring: Current Knowledge and Hemostasis Assessment with Viscoelastic Tests

“…Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) parameters, their definitions, and their interpretations. This table also depicts the different ROTEM assays, their activators, and the differences among them [109][110][111][112][113].…”

Effect of Centhaquine on the Coagulation Cascade in Normal State and Uncontrolled Hemorrhage: A Multiphase Study Combining Ex Vivo and In Vivo Experiments in Different Species

“…However, it should be considered that conventional measures of coagulation may represent distinct mechanisms independent of biochemical clot strength [ 18 ] and also overestimate TIC in stable trauma patients [ 19 , 20 ]. On the other hand, thromboelastography (TEG) can account for the balance of coagulation—taking into account both clotting factors and endogenous anticoagulant proteins—and provide insights into clot formation, clot stability through platelet–fibrin interactions, and clot retraction and/or lysis [ 21 ]. As correlations between TEG parameters and standard laboratory results may not be perfect [ 22 , 23 ], especially in critically ill patients, an effect of centhaquine on blood coagulation remains possible.…”