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Global Coagulation Testing in Acute Care Medicine: Back to Bedside?
Michael Caspers1,2, Johannes Fabian Holle3, Ulrich Limper4
1Department of Medicine, The Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Cologne, Germany.
Hamostaseologie
|December 22, 2022
Summary
Viscoelastic hemostatic assays (VHAs) offer rapid, bedside assessment of coagulation status, guiding goal-directed coagulation therapies (GDCT) in emergencies. VHA-based algorithms are increasingly used in trauma and bleeding management guidelines.
Area of Science:
- Emergency Medicine
- Hematology
- Critical Care
Background:
- Accurate coagulation status assessment is vital in emergencies.
- Conventional tests have limitations, especially with direct oral anticoagulants (DOACs).
- DOACs present diagnostic challenges in emergency settings.
Purpose of the Study:
- To review the evidence for viscoelastic hemostatic assays (VHAs) in guiding goal-directed coagulation therapies (GDCT).
- To focus on VHA-based GDCT in trauma and intracerebral bleeding/stroke management.
- To discuss the advantages and challenges of VHA use in emergency situations.
Main Methods:
- Qualitative review of current evidence on VHA-based GDCT.
- Focus on VHA application in specific clinical scenarios.
- Analysis of VHA advantages and limitations.
Main Results:
- VHA-based algorithms are increasingly incorporated into international guidelines for bleeding risk.
- VHAs provide rapid, bedside point-of-care information on hemostatic deficiencies.
- VHA-based GDCT offers a potential alternative to conventional coagulation testing.
Conclusions:
- VHA-based algorithms are recognized in guidelines for managing bleeding risks.
- VHAs facilitate faster, goal-directed hemostatic control in critical care.
- This review highlights VHA utility and challenges in trauma and stroke management.
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