Viscoelastic testing in benign hematologic disorders: Clinical perspectives and future implications of point‐of‐care testing to assess hemostatic competence

Abstract

Viscoelastic tests (VETs) have been used routinely for liver transplantation, cardiac surgery, and trauma, but only recently have found clinical utility in benign hematologic disorders. Therefore, guidelines for diagnosis and treatment of these disorders based on viscoelastic variables have been adapted from the existing transplant, cardiothoracic surgery, and trauma resuscitation literature. As a result, diagnostic and therapeutic strategies for benign hematologic disorders utilizing VETs are not uniform. Accordingly, even though there has been a recent increase in the utilization of VET for the diagnosis and treatment of such disorders, the literature is still in its early stages. Analysis of point‐of‐care viscoelastic tracings from benign hematologic disorders has the potential to allow prompt recognition of disease and to guide patient‐specific intervention. Here we present a review describing the application of VETs to benign hematologic disorders.

The Choice between Plasma-Based Common Coagulation Tests and Cell-Based Viscoelastic Tests in Monitoring Hemostatic Competence: Not an either–or Proposition

“…113,114 VETs, as with hemophilia A and B, have demonstrated correlation with the severity of disease for patients with congenital FVII deficiency. 110,[113][114][115][116][117][118]…”

“…[96][97][98][99][100][101][102][103][104][105][106] These protocols are important because advances in hemophilia therapy have allowed patients to live long enough to necessitate procedures such as cardiothoracic surgery that require VET-guided treatment for patients with the hemophilias. [106][107][108][109][110] Most of the literature regarding the use of VETs in congenital bleeding disorders involve hemophilia A and B. For the other RBDs, there is less evidence demonstrating the efficacy of these tests.…”

“…96 97 98 99 100 101 102 103 104 105 106 These protocols are important because advances in hemophilia therapy have allowed patients to live long enough to necessitate procedures such as cardiothoracic surgery that require VET-guided treatment for patients with the hemophilias. 106 107 108 109 110…”

Resonant Acoustic Rheometry to Measure Coagulation Kinetics in Hemophilia A and Healthy Plasma: A Novel Viscoelastic Method

“…17 18 19 20 21 22 23 These techniques have demonstrated effective management of hemophilia A by establishing clinical phenotype, perioperative diagnosis and therapy, and personalized titration of anticoagulant agents. 1 24…”

“…[17][18][19][20][21][22][23] These techniques have demonstrated effective management of hemophilia A by establishing clinical phenotype, perioperative diagnosis and therapy, and personalized titration of anticoagulant agents. 1,24 A criticism of clinically available VHA methodologies is that these techniques considerably deform the clot sample, which may yield inconsistent results. These techniques typically use either a rotating cup and pin system (e.g., TEG 5000, ROTEM delta, and ROTEM sigma), a vertical cup and pin system (e.g., Sonoclot), or vibration detection by light-emitting diode (e.g., TEG 6s).…”