Should viscoelastic testing be a standard point-of-care test on all intensive care units?

Abstract

Viscoelastic tests (VETs) have transformed assessment of haemostasis and transfusion practices in trauma, cardiac and liver transplantation centres. Impaired haemostasis is a common problem on the general intensive care unit (ICU), but routine use of VETs is rare. We have accordingly reviewed the evidence to determine whether there is evidence to support the use of VETs as a standard point of care test on all ICUs in assessing and managing patients. The benefits of using VETs in the management of major haemorrhage, namely faster identification of a coagulopathy, in particular early detection of fibrinolysis, and reduced transfusion requirements for blood products have been seen in the general ICU. Validation of treatments algorithms is now required to standardise practice. There is also emerging evidence to support the use of VETs to guide urgent treatment decisions in patients with a coagulopathy or in patients taking anti-coagulants or anti-platelet therapies. We recommend that departments independently review the feasibility of setting up a viscoelastic point of care service which considers the applicability to their patient cohort, the financial cost and the personnel required.

Keywords: thromboelastography; thromboelastometry; viscoelastic test.

Figure 1.

Potential benefits of using viscoelastic tests on intensive care units. VET: viscoelastic test; CCT: conventional coagulation test; DOAC: direct oral anti-coagulants.

Figure 2.

Special patient groups: possible applications of viscoelastic tests. VET: viscoelastic test; MOH: major obstetric haemorrhage.

Figure 3.

Practical considerations of setting up a viscoelastic point of care service on intensive care units. IR: international radiology; von Willebrand Factor.