Viscoelastic testing: Critical appraisal of new methodologies and current literature

Abstract

AbstractUnited 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.