The clot thickens: How to use viscoelastic testing in critical illness

Abstract

Coagulopathy is common in critically ill patients and may result in complications such as bleeding or thromboembolic events. Viscoelastic testing (VET), including both thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), offers a benefit over conventional coagulation tests in that it provides a qualitative and quantitative assessment of the degree of coagulopathy, including the ability to measure fibrinolysis. This review is a “how‐to” primer for critical care pharmacists to interpret and utilize VET in practice across a spectrum of coagulopathies, including trauma and traumatic brain injury, neurologic injury and emergencies, cardiothoracic surgery, liver disease, and medication‐induced coagulopathy.

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…”