Clinical utility of thromboelastography: one size does not fit all

Coagulation management requires the balancing of different components that contribute to clot formation. These components include the interactions between platelets, procoagulant, anticoagulant, and fibrinolytic factors. The cause of bleeding or thrombotic events is often multifactorial; however, the tests clinicians most frequently use to assess hemostasis do not reflect the complexity of the coagulation system. The paucity of global measurements of hemostasis has resulted in either an empirical or a one-size-fits-all approach to treatment. In contrast, thromboelastography is a test that monitors the different phases of clot formation and lysis, providing the clinician with a tool for making informed therapeutic decisions. This review provides an overview of thromboelastography in the management of hypocoagulable and hypercoagulable conditions.