Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Oksana Volod; Connor M. Bunch; Nuha Zackariya; Ernest E. Moore; Hunter B. Moore; Hau C. Kwaan; Matthew D. Neal; Mahmoud D. Al-Fadhl; Shivani S. Patel; Grant Wiarda; Hamid D. Al-Fadhl; Max L. McCoy; Anthony V. Thomas; Scott G. Thomas; Laura Gillespie; Rashid Z. Khan; Mahmud Zamlut; Peter Kamphues; Dietmar Fries; Mark M. Walsh

doi:10.3390/jcm11030860

Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Oksana Volod, Connor M. Bunch, Nuha Zackariya, Ernest E. Moore, Hunter B. Moore, Hau C. Kwaan, Matthew D. Neal, Mahmoud D. Al-Fadhl, Shivani S. Patel, Grant Wiarda, Hamid D. Al-Fadhl, Max L. McCoy, Anthony V. Thomas, Scott G. Thomas, Laura Gillespie, Rashid Z. Khan, Mahmud Zamlut, Peter Kamphues, Dietmar Fries, Mark M. Walsh^*

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Review article › peer-review

60 Scopus citations

Abstract

Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.

Original language	English (US)
Article number	860
Journal	Journal of Clinical Medicine
Volume	11
Issue number	3
DOIs	https://doi.org/10.3390/jcm11030860
State	Published - Feb 1 2022

Funding

Conflicts of Interest: O.V. is a consultant for Haemonetics Corporation (Boston, MA, USA), served on the Clinical Care Improvement Steering Committee for Diagnostica Stago, Inc., and received honoraria for consultancy outside the submitted work. E.E.M., H.B.M., M.D.N. and M.M.W. have received research grants from Haemonetics Corporation outside the submitted work. M.D.N. has received an honorarium from Haemonetics Corporation for speaking engagements, as well as research support from Janssen Pharmaceuticals (Beerse, Belgium) and Noveome Biotherapeutics (Pittsburgh, PA, USA) outside the submitted work. He has served as a consultant to Janssen and CSL Behring (King of Prussia, PA, USA) and serves on the Scientific Advisory Board of Haima Therapeutics (Cleveland, OH, USA). M.M.W. has received honoraria from Alexion Pharmaceuticals (Boston, MA, USA). D.F. has received study funding, honoraria for consultancy, and shows board activity from Astra Zeneca, AOP orphan, Baxter, Bayer, B. Braun Medical, Biotest, CSL Behring, Delta Select, Dade Behring, Edwards, Fresenius, Glaxo, Haemoscope, Hemogem, Lilly, LFB, Mitsubishi Pharma, Novo Nordisk, Octapharma, Pfizer, and Tem Innovations outside the submitted work.

Keywords

COVID-19
Coagulopathy
Fibrinogen
Hemorrhage
Heparin
Personalized medicine
Rotational thromboelastometry
Thromboelastography
Thrombosis

ASJC Scopus subject areas

General Medicine

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10.3390/jcm11030860

Cite this

Volod, O., Bunch, C. M., Zackariya, N., Moore, E. E., Moore, H. B., Kwaan, H. C., Neal, M. D., Al-Fadhl, M. D., Patel, S. S., Wiarda, G., Al-Fadhl, H. D., McCoy, M. L., Thomas, A. V., Thomas, S. G., Gillespie, L., Khan, R. Z., Zamlut, M., Kamphues, P., Fries, D., & Walsh, M. M. (2022). Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. Journal of Clinical Medicine, 11(3), Article 860. https://doi.org/10.3390/jcm11030860

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abstract = "Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG{\textregistered} 5000) and rotational thromboelastometry (ROTEM{\textregistered} delta), have been supplanted not only by cartridge systems (TEG{\textregistered} 6S and ROTEM{\textregistered} sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot{\textregistered}, Quantra{\textregistered}, and ClotPro{\textregistered}). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.",

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author = "Oksana Volod and Bunch, {Connor M.} and Nuha Zackariya and Moore, {Ernest E.} and Moore, {Hunter B.} and Kwaan, {Hau C.} and Neal, {Matthew D.} and Al-Fadhl, {Mahmoud D.} and Patel, {Shivani S.} and Grant Wiarda and Al-Fadhl, {Hamid D.} and McCoy, {Max L.} and Thomas, {Anthony V.} and Thomas, {Scott G.} and Laura Gillespie and Khan, {Rashid Z.} and Mahmud Zamlut and Peter Kamphues and Dietmar Fries and Walsh, {Mark M.}",

note = "Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.",

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Volod, O, Bunch, CM, Zackariya, N, Moore, EE, Moore, HB, Kwaan, HC, Neal, MD, Al-Fadhl, MD, Patel, SS, Wiarda, G, Al-Fadhl, HD, McCoy, ML, Thomas, AV, Thomas, SG, Gillespie, L, Khan, RZ, Zamlut, M, Kamphues, P, Fries, D & Walsh, MM 2022, 'Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices', Journal of Clinical Medicine, vol. 11, no. 3, 860. https://doi.org/10.3390/jcm11030860

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T2 - A Primer on Legacy and New Generation Devices

AU - Volod, Oksana

AU - Bunch, Connor M.

AU - Zackariya, Nuha

AU - Moore, Ernest E.

AU - Moore, Hunter B.

AU - Kwaan, Hau C.

AU - Neal, Matthew D.

AU - Al-Fadhl, Mahmoud D.

AU - Patel, Shivani S.

AU - Wiarda, Grant

AU - Al-Fadhl, Hamid D.

AU - McCoy, Max L.

AU - Thomas, Anthony V.

AU - Thomas, Scott G.

AU - Gillespie, Laura

AU - Khan, Rashid Z.

AU - Zamlut, Mahmud

AU - Kamphues, Peter

AU - Fries, Dietmar

AU - Walsh, Mark M.

PY - 2022/2/1

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N2 - Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.

AB - Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.

KW - COVID-19

KW - Coagulopathy

KW - Fibrinogen

KW - Hemorrhage

KW - Heparin

KW - Personalized medicine

KW - Rotational thromboelastometry

KW - Thromboelastography

KW - Thrombosis

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M3 - Review article

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SN - 2077-0383

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JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

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ER -

Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Abstract

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Keywords

ASJC Scopus subject areas

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