Viscoelastic methods in clinical laboratory hematology: a narrative review
Abstract
Viscoelastic methods (VEMs) such as thromboelastography (TEG) and thromboelastometry (TEM) offer a comprehensive assessment of hemostasis, starting with early stages of coagulation, through fibrin clot formation, and ending with fibrinolysis. They offer several advantages compared to the standard coagulation tests i.e. they allow a detailed assessment in real time of the coagulation process with the contribution of platelets and fibrinogen levels in the whole blood. TEG or TEM point-of-care devices are widely used in managing intraoperative bleeding, especially in the context of cardiac surgery. The latest study results indicate a growing interest in VEMs in various fields of hematology. TEG and TEM have been used in congenital bleeding disorders such as hemophilia and von Willebrand disease. Both assays offer more objective and complete laboratory evaluation of an individual patient’s phenotype, effective personalized prophylaxis, the management of bypassing agent therapy, and the management of spontaneous bleeding episodes or surgery. We have therefore carried out a narrative review to summarize evidence on the usefulness of VEMs in the assessment of blood coagulation and fibrinolysis in these bleeding disorders.
Keywords: viscoelastic methods (VEMs)thromboelastography (TEG)thromboelastometry (TEM)hemophiliavon Willebrand disease
References
- Hartert H. [Blood clotting studies with Thrombus stressography; a new Investigation procedure] [Article in German]. Klin Wochenschr. 1948; 26(37-38): 577–583.
- Sahli SD, Rössler J, Tscholl DW, et al. Point-of-care diagnostics in coagulation management. Sensors (Basel). 2020; 20(15).
- Curry NS, Davenport R, Pavord S, et al. The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline. Br J Haematol. 2018; 182(6): 789–806.
- Selby R. "TEG talk": expanding clinical roles for thromboelastography and rotational thromboelastometry. Hematology Am Soc Hematol Educ Program. 2020; 2020(1): 67–75.
- Korpallová B, Samoš M, Bolek T, et al. Role of thromboelastography and rotational thromboelastometry in the management of cardiovascular diseases. Clin Appl Thromb Hemost. 2018; 24(8): 1199–1207.
- Tirotta CF, Lagueruela RG, Salyakina D, et al. Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients. J Cardiothorac Surg. 2019; 14(1): 139.
- Dieu A, Van Regemorter V, Detaille T, et al. Combined use of rotational thromboelastometry (Rotem) and platelet impedance aggregometry (Multiplate Analyzer) in cyanotic and acyanotic infants and children undergoing cardiac surgery with cardiopulmonary bypass: subgroup analysis of a randomized clinical trial. J Cardiothorac Vasc Anesth. 2021; 35(7): 2115–2123.
- Tran HTT, Sørensen B, Bjørnsen S, et al. Monitoring bypassing agent therapy — a prospective crossover study comparing thromboelastometry and thrombin generation assay. Haemophilia. 2015; 21(2): 275–283.
- Chen P, Jani J, Streiff MB, et al. Evaluation of global hemostatic assays in response to factor VIII inhibitors. Clin Appl Thromb Hemost. 2019; 25: 1076029619836171.
- Pivalizza EG, Escobar MA. Thrombelastography-guided factor VIIa therapy in a surgical patient with severe hemophilia and factor VIII inhibitor. Anesth Analg. 2008; 107(2): 398–401.
- Furukawa S, Nogami K, Ogiwara K, et al. Systematic monitoring of hemostatic management in hemophilia A patients with inhibitor in the perioperative period using rotational thromboelastometry. J Thromb Haemost. 2015; 13(7): 1279–1284.
- Ramiz S, Hartmann J, Young G, et al. Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia. Am J Hematol. 2019; 94(2): 249–256.
- Yada K, Nogami K, Shida Y, et al. Enhanced global hemostatic potentials with a bispecific antibody to factors IXa and X (ACE910) in the whole blood by rotation thromboelastometry (ROTEM). Blood. 2015; 126(23): 3503–3503.
- Oldenburg J, Mahlangu JN, Kim B, et al. Emicizumab prophylaxis in hemophilia A with inhibitors. N Engl J Med. 2017; 377(9): 809–818.
- Yada K, Nogami K, Ogiwara K, et al. Global coagulation function assessed by rotational thromboelastometry predicts coagulation-steady state in individual hemophilia A patients receiving emicizumab prophylaxis. Int J Hematol. 2019; 110(4): 419–430.
- Regling K, Kakulavarapu S, Thomas R, et al. Utility of thromboelastography for the diagnosis of von Willebrand disease. Pediatr Blood Cancer. 2019; 66(7): e27714.
- Topf HG, Strasser ER, Breuer G, et al. Closing the gap — detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational Thromboelastometry. BMC Anesthesiol. 2019; 19(1): 10.
- Grant HW, Hadley GP. Prediction of neonatal sepsis by thromboelastography. Pediatr Surg Int. 1997; 12(4): 289–292.
- Sokou R, Giallouros G, Konstantinidi A, et al. Thromboelastometry for diagnosis of neonatal sepsis-associated coagulopathy: an observational study. Eur J Pediatr. 2018; 177(3): 355–362.
- Almskog LM, Wikman A, Svensson J, et al. Rotational thromboelastometry results are associated with care level in COVID-19. J Thromb Thrombolysis. 2021; 51(2): 437–445.
- Creel-Bulos C, Auld SC, Caridi-Scheible M, et al. Fibrinolysis shutdown and thrombosis in a COVID-19 ICU. Shock. 2021; 55(3): 316–320.
- Słomka A, Kowalewski M, Żekanowska E. Hemostasis in coronavirus disease 2019-lesson from viscoelastic methods: a systematic review. Thromb Haemost. 2021 [Epub ahead of print].
