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.