Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Area of Science:

• Hematology
• Medical Devices
• Point-of-Care Testing

Background:

• Viscoelastic hemostatic assays (VHAs) are vital whole blood point-of-care tests.
• VHAs are essential for assessing hemostatic competence in liver transplantation, cardiac surgery, and trauma surgery.
• VHA technology has become mainstream after decades of research and clinical application.

Purpose of the Study:

• To compare legacy and new generation VHAs.
• To analyze hemostatic parameters including coagulation factors, fibrinogen/fibrin, platelets, and clot lysis.
• To discuss the adoption of VHAs for managing COVID-19-associated coagulopathy.

Main Methods:

• Comparison of legacy devices (e.g., TEG 5000, ROTEM delta) and newer cartridge systems (e.g., TEG 6S, ROTEM sigma).
• Inclusion of portable point-of-care bedside testing iterations (e.g., Sonoclot, Quantra, ClotPro).
• Analysis based on unique hemostatic parameters defining clot lifespan contributions.

Main Results:

• Legacy VHA devices are being replaced by cartridge systems and portable bedside iterations.
• VHAs provide comprehensive assessment of hemostasis, including factors, fibrin, platelets, and lysis.
• Newer VHAs offer advancements in portability and potentially user-friendliness.

Conclusions:

• VHAs have evolved significantly, with new generations offering improved features.
• The adoption of VHAs has accelerated across medical and surgical fields.
• VHAs play a critical role in managing complex coagulopathies, including those associated with COVID-19.