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

Research output: Contribution to journalReview articlepeer-review

36 Scopus citations


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 languageEnglish (US)
Article number860
JournalJournal of Clinical Medicine
Issue number3
StatePublished - Feb 1 2022


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

ASJC Scopus subject areas

  • Medicine(all)


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