The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?
Abstract
:1. Introduction and Principles of Viscoelastic Testing
2. Evidence for Use of VET
2.1. Direct Oral Anticoagulants
2.2. Liver Disease
2.3. Orthotopic Liver Transplantation
2.4. Cardiothoracic Surgery
2.5. Trauma
2.6. Obstetrics
2.7. Pediatrics
3. Challenges and Future Directions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Variable | Significance | TEG® | ROTEM® |
---|---|---|---|
Time [minutes] from start of 2 mm above baseline | Clotting factor deficiency if prolonged | Reaction Time [R] | Clotting time [CT] |
Time [minutes] from 2 mm above baseline to 20 mm above baseline | Hypofibrinogemia if prolonged | Kinetics Time [K] | Clot formation time [CFT] |
Alpha [α] angle [°] | Measures the slope between clot initiation and formation, representing thrombin propagation | Angle between end of R time and slope of curve | Angle between end of CT to slope of the curve |
Maximum strength [mm] and peak amplitude of waveform | Low fibrinogen, low platelets or platelet dysfunction if reduced | Maximal Amplitude [MA] | Maximal clot firmness [MCF] |
Time [minutes] to Maximum Clot Firmness | Hypofibrinogemia if prolonged | - | MCF-t |
Clot Lysis | Detection of hyperfibrinolysis | CLT [time taken for amplitude to decrease by 2 mm from MA] | LY30, LY45, LY60 [percentage drop in amplitude of MCF at 30, 45 and 60 min] |
Clot elasticity [dyn/cm2] | Clot ‘firmness’ | G | MCE |
Maximum Lysis | Detection of hyperfibrinolysis | - | ML |
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Reardon, B.; Pasalic, L.; Favaloro, E.J. The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays? J. Clin. Med. 2024, 13, 3612. https://doi.org/10.3390/jcm13123612
Reardon B, Pasalic L, Favaloro EJ. The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays? Journal of Clinical Medicine. 2024; 13(12):3612. https://doi.org/10.3390/jcm13123612
Chicago/Turabian StyleReardon, Benjamin, Leonardo Pasalic, and Emmanuel J. Favaloro. 2024. "The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?" Journal of Clinical Medicine 13, no. 12: 3612. https://doi.org/10.3390/jcm13123612