Future directions in viscoelastic hemostatic assay usage in bleeding patients

Area of Science:

• Coagulation science
• Point-of-care diagnostics
• Perioperative medicine

Background:

• Severe bleeding and coagulopathy are critical challenges in cardiac surgery, trauma, and obstetrics.
• Viscoelastic hemostatic assays (VHAs) are point-of-care tools for rapid coagulation assessment.
• Evidence and clinical integration of VHAs are inconsistent.

Purpose of the Study:

• To review current evidence on VHAs.
• To highlight limitations of existing VHA platforms.
• To identify opportunities for VHA refinement and improved clinical application.

Main Methods:

• Review of current scientific literature on VHAs.
• Analysis of evidence from randomized trials and international guidelines.
• Identification of challenges in VHA heterogeneity and interpretation.

Main Results:

• VHAs provide faster, more functional coagulation assessment than conventional tests.
• International guidelines support VHA use, but trial results are conflicting.
• Heterogeneity in platforms, assays, and interpretation poses significant challenges.
• Specific parameters like fibrinogen contribution and clotting time need refinement.

Conclusions:

• VHAs are valuable for bleeding management but limited by heterogeneity and accuracy.
• Standardization of assays and algorithms is crucial.
• Further research should focus on improving specificity and predictive accuracy for reliable clinical algorithms.