Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Abstract

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non‐trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.

Continuing excellence in critical care pharmacy practice, education, and advocacy

“…Interpreting complicated pharmacokinetics/pharmacodynamics using advanced therapeutic drug monitoring, 5 evaluation of patient clinical status and organ function, 6 or the ordering and utilization of procedures or laboratory assays to provide optimal pharmacotherapy are now common practice for most critical care pharmacists. 7,8 Critical care pharmacist participation on the multidisciplinary team has also demonstrated considerable benefits in areas such as anticoagulation, 9,10 antimicrobial therapy, 11 pain, agitation and sleep management, [12][13][14] and overall medication safety. 15 The ICU Liberation Campaign represents bundled interventions conducted by an interdisciplinary team, including a critical care pharmacist that has been associated with improvement in survival, ICU length of stay, and ICU readmission.…”

“…Pharmacists are well versed in the application of various technologies and measurements that can quickly be used at the bedside to optimize therapy. 7,8 Additionally, critical care pharmacists improve the efficiency and speed of appropriate medication availability in emergent situations. 10…”