title: Use of viscoelastic haemostatic assay in emergency and elective surgery.
abstract: OBJECTIVE
  To review the current evidence for the use of viscoelastic haemostatic assays in different surgical settings including trauma, cardiac surgery, liver transplantation, as well as the monitoring of antiplatelet agents and anticoagulants prior to surgery.
  
  
  METHODS
  PubMed database.
  
  
  METHODS
  Key words for the literature search were "thromboelastography" or "ROTEM" in combination with "trauma", "antiplatelet", "cardiac surgery", "liver transplantation" or "anticoagulants".
  
  
  METHODS
  Original and major review articles related to the use of viscoelastic haemostatic assays.
  
  
  RESULTS
  Haemostatic function is a critical factor determining patient outcomes in emergency or elective surgery. The increasing use of antiplatelet agents and anticoagulants has potentially increased the risks of haemorrhages and the need for transfusion. Conventional coagulation tests have limitations in detecting haemostatic dysfunctions in subgroups of patients and are largely ineffective in diagnosing hyperfibrinolysis. The viscoelastic haemostatic assays are potentially useful point-of-care tools that provide information on clot formation, clot strength, and fibrinolysis, as well as to guide goal-directed transfusion and antifibrinolytic therapy. They may also be used to monitor antiplatelet and anticoagulant therapy. However, standardisation of techniques and reference ranges is required before these tests can be widely used in different clinical settings.
  
  
  CONCLUSIONS
  Viscoelastic haemostatic assays, as compared with conventional coagulation tests, are better for detecting coagulopathy and are the only tests that can provide rapid diagnosis of hyperfibrinolysis. Goal-directed administration of blood products based on the results of viscoelastic haemostatic assays was associated with reduction in allogeneic blood product transfusions in trauma, cardiac surgery, and liver transplantation cases. However, there is currently no evidence to support the routine use of viscoelastic haemostatic assays for monitoring platelet function prior to surgery.
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Maximus C F
authors.initials: MC
authors.lastname: Yeung
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Steven Y T
authors.initials: SY
authors.lastname: Tong
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Paul Y W
authors.initials: PY
authors.lastname: Tong
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Billy H H
authors.initials: BH
authors.lastname: Cheung
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Joanne Y W
authors.initials: JY
authors.lastname: Ng
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Gilberto K K
authors.initials: GK
authors.lastname: Leung
mesh_terms: D000925:Anticoagulants / Q000097:blood; D017558:Elective Surgical Procedures; D006474:Hemorrhagic Disorders / Q000175:diagnosis; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000097:blood; D011300:Preoperative Care / Q000379:methods; D013514:Surgical Procedures, Operative / Q000379:methods*; D013916:Thrombelastography / Q000379:methods*; D055682:Viscoelastic Substances
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D055682:Viscoelastic Substances
keywords: Anticoagulants; Liver transplantation; Thoracic surgery; Thrombelastography; Wounds and injuries