Practical use of viscoelastic methods

Review

The applications of viscoelastic methods in perioperative care and in the management of life-threatening bleeding are nowadays necessary and important. The great advantage of these methods, in contrast to laboratory hemocoagulation tests, is the evaluation of the whole process of clot formation and its lysis in a very short time. They are done at the patient's bedside without the need of transportation to the laboratory. The validity of this approach is supported by the physiology and pathophysiology of a relatively new "cellular model of hemostasis". Thanks to a simple algorithm, rapid differential diagnosis of coagulopathy is possible, from the diagnosis of deficiency of coagulation factor or platelets, hyperfibrinolysis to the presence of the latest oral anticoagulants. The algorithm presents an everyday situation, in which thanks to the rapid diagnosis of coagulopathy, it is possible to target the necessary coagulation factors and a specific antidote. This approach prevents unnecessary and excessive administration of plasma and other coagulation factors. The unjustified administration of these may expose the patient to the risk of thrombosis or other associated complications.