Marsee Mathew K, Shariff Faisal S, Wiarda Grant, Watson Patrick J, Sualeh Ali H, Brenner Toby J, McCoy Max L, Al-Fadhl Hamid D, Jones Alexander J, Davis Patrick K, Zimmer David, Folsom Craig
Department of Graduate Medical Education, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA.
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
J Clin Med. 2022 Feb 20;11(4):1119. doi: 10.3390/jcm11041119.
In the field of otolaryngology-head and neck surgery (ENT), coagulopathies present unique diagnostic and therapeutic challenges. In both hyper- and hypocoagulable patients, management of coagulopathies requires intricate attention to the nature of hemostatic competence. Common coagulation tests (CCTs) offer only a snapshot of hemostatic competence and do not provide a clear insight into the patient's real-time hemostatic condition. Viscoelastic tests (VETs) offer a holistic and concurrent picture of the coagulation process. Although VETs have found prominent utilization in hepatic transplants, obstetrics, and emergent surgical settings, they have not been fully adopted in the realm of otolaryngology. The objective of this manuscript is to provide an overview of the literature evaluating the current utilization and possible future uses of VETs in the field of otolaryngology. The authors performed a comprehensive literature search of the utilization of VETs in otolaryngology and identified applicable studies that included descriptions of viscoelastic testing. Twenty-five studies were identified in this search, spanning topics from head and neck oncology, microvascular free flap reconstruction, obstructive sleep apnea, adenotonsillectomy, facial trauma, and epistaxis. The applicability of VETs has been demonstrated in head and neck oncology and microvascular free flap management, although their pervasiveness in practice is limited. Underutilization of VETs in the field of otolaryngology may be due to a lack of familiarity of the tests amongst practitioners. Instead, most otolaryngologists continue to rely on CCTs, including PT, PTT, INR, CBC, fibrinogen levels, and thrombin time. Learning to perform, interpret, and skillfully employ VETs in clinical and operative practice can greatly improve the management of coagulopathic patients who are at increased risk of bleeding or thrombosis.
在耳鼻咽喉-头颈外科（ENT）领域，凝血病带来了独特的诊断和治疗挑战。在高凝和低凝患者中，凝血病的管理都需要对止血能力的性质给予细致关注。常规凝血试验（CCTs）仅能提供止血能力的一个快照，无法清晰洞察患者的实时止血状况。粘弹性试验（VETs）能提供凝血过程的整体和同步情况。尽管VETs在肝移植、产科和急诊手术环境中已得到广泛应用，但在耳鼻咽喉科领域尚未被充分采用。本文的目的是概述评估VETs在耳鼻咽喉科领域当前应用及未来可能用途的文献。作者对VETs在耳鼻咽喉科的应用进行了全面的文献检索，并确定了包括粘弹性测试描述的适用研究。在此次检索中确定了25项研究，涵盖了头颈肿瘤学、微血管游离皮瓣重建、阻塞性睡眠呼吸暂停、腺样体扁桃体切除术、面部创伤和鼻出血等主题。VETs的适用性已在头颈肿瘤学和微血管游离皮瓣管理中得到证明，尽管它们在实践中的普及程度有限。耳鼻咽喉科领域对VETs利用不足可能是由于从业者对这些测试缺乏熟悉度。相反，大多数耳鼻咽喉科医生继续依赖CCTs，包括PT、PTT、INR、CBC、纤维蛋白原水平和凝血酶时间。学会在临床和手术实践中进行、解释并熟练运用VETs，可极大地改善对有出血或血栓形成风险增加的凝血病患者的管理。
