Skip to main content
SpringerLink
Log in

Viscoelastic Tests of Hemostasis

  • Chapter
  • First Online:
Perioperative Hemostasis

  • 2403 Accesses

Abstract

Viscoelastic tests (thromboelastography) were developed more than 60 years ago to assess bleeding and coagulation. Today, technical innovations and computer technology have brought these techniques to the bedside.

Two types of point-of-care devices which assess viscoelastic changes in clotting whole blood are available on the market. They allow a dynamic assessment of the interaction between coagulation factors, inhibitors and cellular components during the clotting phase and subsequent lysis.

Technical differences, as well as the specific coagulation activators used in each device, must be understood in order to correctly apply the results to clinical settings.

This chapter reviews the technology related to viscoelastic exams, the tests and reagents used, as well as the differences between the devices available on the market.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Afshari A, Wikkelso A et al (2011) Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev (3):CD007871

    Google Scholar 

  • Ak K, Isbir CS et al (2009) Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study. J Card Surg 24(4):404–410

    Article  PubMed  Google Scholar 

  • Brohi K (2009) Diagnosis and management of coagulopathy after major trauma. Br J Surg 96(9):963–964

    Article  CAS  PubMed  Google Scholar 

  • Camenzind V, Bombeli T et al (2000) Citrate storage affects thrombelastograph analysis. Anesthesiology 92(5):1242–1249

    Article  CAS  PubMed  Google Scholar 

  • Chitlur M, Sorensen B et al (2011) Standardization of thromboelastography: a report from the TEG-ROTEM working group. Haemophilia 17(3):532–537

    Article  CAS  PubMed  Google Scholar 

  • Davenport R, Manson J et al (2011) Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med 39(12):2652–2658

    PubMed Central  PubMed  Google Scholar 

  • Ganter MT, Hofer CK (2008) Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg 106(5):1366–1375

    Article  PubMed  Google Scholar 

  • Gorlinger K, Dirkmann D et al (2011) First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 115(6):1179–1191

    PubMed  Google Scholar 

  • Haemoscope Corporation (2007) Specifications and performance characteristics. In: TEG5000 thromboelastograph hemostasis system user manual. Haemoscope Corporation: Niles, USA p 177

    Google Scholar 

  • Hartert H (1948) Blutgerinningsstudien mit der thrombelastographie, einem neuen untersuchingsverfahren. Klin Wochenschr 26(37–38):577–583

    Google Scholar 

  • Holcomb JB, Minei KM et al (2012) Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. Ann Surg 256(3):476–486

    Article  PubMed  Google Scholar 

  • Jambor C, Reul V et al (2009) In vitro inhibition of factor XIII retards clot formation, reduces clot firmness, and increases fibrinolytic effects in whole blood. Anesth Analg 109(4):1023–1028

    Article  PubMed  Google Scholar 

  • Johansson PI (2009) Hemostatic strategies for minimizing mortality in surgery with major blood loss. Curr Opin Hematol 16(6):509–514

    Article  PubMed  Google Scholar 

  • Johansson PI, Sorensen AM et al (2013) Low hemorrhage-related mortality in trauma patients in a level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets. Transfusion 53(12):3088–3099

    Article  CAS  PubMed  Google Scholar 

  • Kashuk JL, Moore EE et al (2012) Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy. Transfusion 52(1):23–33

    Article  PubMed  Google Scholar 

  • Kitchen DP, Kitchen S et al (2010) Quality assurance and quality control of thrombelastography and rotational thromboelastometry: the UK NEQAS for blood coagulation experience. Semin Thromb Hemost 36(7):757–763

    Article  PubMed  Google Scholar 

  • Lang T, Bauters A et al (2005) Multi-centre investigation on reference ranges for ROTEM thromboelastometry. Blood Coagul Fibrinolysis 16(4):301–310

    Article  PubMed  Google Scholar 

  • Larsen OH, Fenger-Eriksen C et al (2011) Diagnostic performance and therapeutic consequence of thromboelastometry activated by kaolin versus a panel of specific reagents. Anesthesiology 115(2):294–302

    Article  CAS  PubMed  Google Scholar 

  • Levrat A, Gros A et al (2008) Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Br J Anaesth 100(6):792–797

    Article  CAS  PubMed  Google Scholar 

  • McCrath DJ, Cerboni E et al (2005) Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg 100(6):1576–1583

    Article  PubMed  Google Scholar 

  • Nair SC, Dargaud Y et al (2010) Tests of global haemostasis and their applications in bleeding disorders. Haemophilia 16(Suppl 5):85–92

    Article  PubMed  Google Scholar 

  • Nielsen VG (2007) A comparison of the thrombelastograph and the ROTEM. Blood Coagul Fibrinolysis 18(3):247–252

    Article  PubMed  Google Scholar 

  • Nielsen VG, Cohen BM et al (2005) Effects of coagulation factor deficiency on plasma coagulation kinetics determined via thrombelastography: critical roles of fibrinogen and factors II, VII, X and XII. Acta Anaesthesiol Scand 49(2):222–231

    Article  CAS  PubMed  Google Scholar 

  • Rahe-Meyer N, Solomon C et al (2009) Multicentric comparison of single portion reagents and liquid reagents for thromboelastometry. Blood Coagul Fibrinolysis 20(3):218–222

    Article  PubMed  Google Scholar 

  • Roche AM, James MF et al (2006) Just scratching the surface: varied coagulation effects of polymer containers on TEG variables. Eur J Anaesthesiol 23(1):45–49

    Article  CAS  PubMed  Google Scholar 

  • Romlin BS, Wahlander H et al (2013) Earlier detection of coagulopathy with thromboelastometry during pediatric cardiac surgery: a prospective observational study. Paediatr Anaesth 23(3):222–227

    Article  PubMed  Google Scholar 

  • Solomon C, Cadamuro J et al (2011) A comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by thromboelastometry, before and after administration of fibrinogen concentrate in cardiac surgery patients. Transfusion 51(8):1695–1706

    Article  CAS  PubMed  Google Scholar 

  • Solomon C, Sorensen B et al (2012) Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry. Anesth Analg 114(4):721–730

    Article  CAS  PubMed  Google Scholar 

  • Sorensen B, Ingerslev J (2005) Tailoring haemostatic treatment to patient requirements - an update on monitoring haemostatic response using thrombelastography. Haemophilia 11(Suppl 1):1–6

    Article  PubMed  Google Scholar 

  • Spalding GJ, Hartrumpf M et al (2007) Cost reduction of perioperative coagulation management in cardiac surgery: value of “bedside” thrombelastography (ROTEM). Eur J Cardiothorac Surg 31(6):1052–1057

    Article  PubMed  Google Scholar 

  • Tapia NM, Chang A et al (2013) TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients. J Trauma Acute Care Surg 74(2):378–385, discussion 385–376

    Article  CAS  PubMed  Google Scholar 

  • Theusinger OM, Baulig W et al (2010a) In vitro factor XIII supplementation increases clot firmness in rotation thromboelastometry (ROTEM). Thromb Haemost 104(2):385–391

    Article  CAS  PubMed  Google Scholar 

  • Theusinger OM, Nurnberg J et al (2010b) Rotation thromboelastometry (ROTEM) stability and reproducibility over time. Eur J Cardiothorac Surg 37(3):677–683

    Article  PubMed  Google Scholar 

  • Venema LF, Post WJ et al (2010) An assessment of clinical interchangeability of TEG and RoTEM thromboelastographic variables in cardiac surgical patients. Anesth Analg 111(2):339–344

    Article  PubMed  Google Scholar 

  • Wallin O, Soderberg J et al (2008) Preanalytical effects of pneumatic tube transport on routine haematology, coagulation parameters, platelet function and global coagulation. Clin Chem Lab Med 46(10):1443–1449

    Article  CAS  PubMed  Google Scholar 

  • Westbrook AJ, Olsen J et al (2009) Protocol based on thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study. Heart Lung Circ 18(4):277–288

    Article  PubMed  Google Scholar 

  • Wilson D, Cooke EA et al (2001) Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture. Injury 32(10):765–770

    Article  CAS  PubMed  Google Scholar 

  • Zambruni A, Thalheimer U et al (2004) Thromboelastography with citrated blood: comparability with native blood, stability of citrate storage and effect of repeated sampling. Blood Coagul Fibrinolysis 15(1):103–107

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’Anesthésie, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne Suisse, CH-1011, Switzerland

    Catherine Heim & Patrick Schoettker

Authors
  1. Catherine Heim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Schoettker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine Heim .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Carlo Enrique Marcucci

  2. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Patrick Schoettker

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Heim, C., Schoettker, P. (2015). Viscoelastic Tests of Hemostasis. In: Marcucci, C., Schoettker, P. (eds) Perioperative Hemostasis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55004-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-55004-1_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-55003-4

  • Online ISBN: 978-3-642-55004-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation