Viscoelastic testing inside and beyond the operating room.

Area of Science:

• Anesthesiology
• Hematology
• Surgical Sciences

Background:

• Hemorrhage is a significant cause of perioperative morbidity and mortality.
• Current coagulopathy diagnostics have limitations: slow results, limited specific information, and lack of in vivo applicability.
• Viscoelastic testing offers a potential solution to these diagnostic challenges.

Purpose of the Study:

• To evaluate the clinical efficacy of viscoelastic testing (VET) in managing perioperative coagulopathy.
• To compare VET-guided transfusion strategies with conventional methods in various surgical settings.
• To assess the impact of VET on blood product utilization, mortality, and cost-effectiveness.

Main Methods:

• Systematic reviews and analysis of clinical trials focusing on thromboelastography (TEG) and rotational thromboelastometry (ROTEM).
• Comparison of transfusion rates (packed red blood cells, plasma, platelets) between VET-guided and conventional management groups.
• Evaluation of mortality, re-intervention rates, massive transfusion rates, and cost-effectiveness.

Main Results:

• Systematic reviews, primarily in cardiac surgery, indicate reduced transfusions of packed red blood cells, plasma, and platelets with VET.
• Mortality appears lower in VET groups, without increased surgical re-intervention or massive transfusion rates.
• Cost-effectiveness studies favor VET, though evidence in other clinical areas (sepsis, obstetrics) is based on smaller studies.

Conclusions:

• Viscoelastic testing is a novel and promising method for assessing coagulation status.
• Evidence suggests VET favorably impacts blood product transfusion reduction, especially in cardiac surgery.
• Further large-scale trials are needed to confirm benefits in diverse clinical contexts beyond cardiac surgery.