Thromboelastography and rotational thromboelastometry for the surgical intensivist: A narrative review

Area of Science:

• Coagulation science
• Critical care medicine
• Surgical intensive care

Background:

• Viscoelastic tests (VETs), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), offer comprehensive coagulation assessment at the point-of-care.
• VETs are increasingly used in critically ill surgical patients for managing hemorrhage and thrombosis, surpassing conventional coagulation tests (CCTs).

Purpose of the Study:

• To review current evidence on the application of VETs in patients within the surgical intensive care unit (SICU).

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, EMBASE, Cochrane Library) up to May 30, 2018.
• Articles evaluating VETs in surgical patient populations were critically assessed for relevance and methodology.
• Data on patient characteristics, CCTs/VETs methods, and outcomes were extracted and narratively summarized.

Main Results:

• Out of 2,589 identified articles, 36 were included, predominantly observational studies (86%).
• Evidence supports VET use for guiding blood product transfusion in severe traumatic hemorrhage and predicting bleeding after cardiac surgery.
• VET-guided heparin dosing for venous thromboembolism prophylaxis was not found to be superior to standard methods in SICU patients.

Conclusions:

• Despite their potential, the current evidence base for VETs in SICU is limited by the poor methodological quality of most studies.
• Further high-quality research, including ongoing randomized controlled trials, is crucial to define the definitive role of TEG/ROTEM in SICU patient management.