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Semin Thromb Hemost 2022; 48(07): 769-784
DOI: 10.1055/s-0042-1756302
Review Article

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

Connor M. Bunch
1   Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
,
Margaret Berquist
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Aida Ansari
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Max L. McCoy
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Jack H. Langford
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Toby J. Brenner
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Michael Aboukhaled
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Samuel J. Thomas
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Ethan Peck
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Shivani Patel
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Emily Cancel
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Mahmoud D. Al-Fadhl
3   Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana
,
Nuha Zackariya
3   Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana
,
Anthony V. Thomas
3   Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana
,
John G. Aversa
4   Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Ryan B. Greene
5   Department of Interventional Radiology, St. Joseph Regional Medical Center, Mishawaka, Indiana
,
Christopher W. Seder
6   Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
,
Jacob Speybroeck
7   Department of Orthopedic Surgery, Case Western Medical Center, Cleveland, Ohio
,
Joseph B. Miller
1   Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
,
Hau C. Kwaan
8   Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Mark M. Walsh
2   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
3   Indiana University School of Medicine, Notre Dame Campus, South Bend, Indiana
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Abstract

There has been a significant interest in the last decade in the use of viscoelastic tests (VETs) to determine the hemostatic competence of bleeding patients. Previously, common coagulation tests (CCTs) such as the prothrombin time (PT) and partial thromboplastin time (PTT) were used to assist in the guidance of blood component and hemostatic adjunctive therapy for these patients. However, the experience of decades of VET use in liver failure with transplantation, cardiac surgery, and trauma has now spread to obstetrical hemorrhage and congenital and acquired coagulopathies. Since CCTs measure only 5 to 10% of the lifespan of a clot, these assays have been found to be of limited use for acute surgical and medical conditions, whereby rapid results are required. However, there are medical indications for the PT/PTT that cannot be supplanted by VETs. Therefore, the choice of whether to use a CCT or a VET to guide blood component therapy or hemostatic adjunctive therapy may often require consideration of both methodologies. In this review, we provide examples of the relative indications for CCTs and VETs in monitoring hemostatic competence of bleeding patients.

Keywords

thromboelastography - hemorrhage - thrombosis - anticoagulants


Publication History

Article published online:
29 September 2022

© 2022. Thieme. All rights reserved.

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