Critical Trigger Thresholds for Hemostatic Management: A Narrative Review of Viscoelastic Hemostatic Assay Applications

Zhi-Li Xu^1,2Han Cao^1,2Da-Wei Sun²Jie Xiao^1,2Yuanyuan Yao²Ge Luo²Tingting Wang²Qi Gao²Jing-Cheng Zou²Xinchen Tao²Min Yan^2*

• ¹Shandong Second Medical University, Weifang, China
• ²Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Viscoelastic haemostasis assays (VHA) are increasingly used in clinical practice. These bedside whole-blood tests, commonly implemented through thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are prized for their speed, accuracy, and accessibility, resulting in their increased usage in managing complex cases such as severe trauma, cardiac surgery, postpartum hemorrhage, and liver disease. Despite their widespread use, clear guidelines for regulating coagulation function in surgical patients through VHA remain undefined. This review searched the majority of the literature on VHA in the past decade and discussed the triggers and algorithms for hemostatic management guided by VHA in surgeries with a high risk of major bleeding. It also reviews the potential benefits of VHA over traditional coagulation tests (like prothrombin time and partial thromboplastin time) and clinical judgments, focusing on aspects such as reducing bleeding volume, decreasing use of allogeneic blood products, improving patient outcomes and mortality, and enhancing cost-effectiveness.