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Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures

  • Christiaan N. Mamczak
  • , Jacob Speybroeck
  • , John E. Stillson
  • , Joseph Dynako
  • , Andres Piscoya
  • , Ethan E. Peck
  • , Michael Aboukhaled
  • , Emily Cancel
  • , Michael McDonald
  • , Diego Garcia
  • , John Lovejoy
  • , Stephanie Lubin
  • , Robert Stanton
  • , Matthew E. Kutcher
  • Florida Orthopedic Institute
  • Case Western Reserve University
  • John Peter Smith Hospital Fort Worth
  • University of Mississippi
  • Walter Reed Army Institute of Research
  • St. Joseph Regional Medical Center
  • Naval Medical Readiness and Training Command
  • University of Florida
  • Hôpital Sacré Coeur
  • Nemours Children's Health System

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy—a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis—remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery.

Original languageEnglish
Article number4029
JournalJournal of Clinical Medicine
Volume11
Issue number14
DOIs
StatePublished - Jul 2022
Externally publishedYes

Keywords

  • blood coagulation tests
  • blood transfusion
  • orthopedics
  • rotational thromboelastometry
  • thromboelastography
  • trauma
  • venous thromboembolism

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