School of Medicine, University of Maryland , Baltimore, MD, USA.
Expert Rev Hematol. 2020 Jul;13(7):697-707. doi: 10.1080/17474086.2020.1758929. Epub 2020 May 3.
The methods of viscoelastic coagulation testing (VCT) have evolved since the original invention of thrombelastography over 60 years ago, and new generations of devices are clinically used to guide hemostatic interventions at bedside. The utility of VCTs has been demonstrated in several clinical trials, but diagnostic performance of VCT may vary between devices, various transfusion algorithms, and patient populations.
Working principles and currently available data on the evolving VCTs for coagulation monitoring in acute care settings are reviewed. The PubMed database was used to search pertinent retrospective, prospective, and meta-analysis data on VCTs.
Point-of-care VCTs provide clinically useful information on platelet count, fibrin polymerization, and other procoagulant factor activities in acute bleeding due to trauma or major surgery, and antithrombotic therapy. The addition of fibrin-specific VCT channel has brought renewed attention to early correction of fibrinogen deficiency using fibrinogen-rich component therapy, and stabilization of fibrin with antifibrinolytic agents. Normal reference ranges vary between devices, and diagnostic and treatment algorithms should be specifically established for each device and indication. There is interest in utilizing VCTs in complex coagulation management relating to hemophilia with inhibitors, but the standardized protocol has not been established.
自 60 多年前血栓弹力描记法发明以来，黏弹性凝血检测（VCT）的方法不断发展，新一代设备已在临床上用于指导床边止血干预。几项临床试验已经证明了 VCT 的实用性，但 VCT 的诊断性能可能因设备、各种输血算法和患者人群的不同而有所差异。
本文回顾了用于急性护理环境中凝血监测的不断发展的 VCT 的工作原理和现有数据。使用 PubMed 数据库搜索了有关 VCT 的回顾性、前瞻性和荟萃分析数据。
即时检测 VCT 可提供有关创伤或大手术后急性出血以及抗血栓治疗中血小板计数、纤维蛋白聚合和其他促凝因子活性的临床有用信息。纤维蛋白特异性 VCT 通道的加入重新引起了人们对使用富含纤维蛋白的成分治疗早期纠正纤维蛋白原缺乏以及用抗纤维蛋白溶解剂稳定纤维蛋白的关注。不同设备之间的正常参考范围有所不同，应针对每种设备和适应证专门建立诊断和治疗算法。人们对在与抑制剂相关的血友病的复杂凝血管理中使用 VCT 感兴趣，但尚未建立标准化方案。
