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Viscoelastic testing in oncology patients (including for the diagnosis of fibrinolysis): Review of existing evidence, technology comparison, and clinical utility
Author(s) -
Walsh Mark,
Kwaan Hau,
McCauley Ross,
Marsee Mathew,
Speybroeck Jacob,
Thomas Scott,
Hatch Jordan,
Vande Lune Stefani,
Grisoli Anne,
Wadsworth Sarah,
Shariff Faisal,
Aversa John G.,
Shariff Faadil,
Zackariya Nuha,
Khan Rashid,
Agostini Vanessa,
Campello Elena,
Simioni Paolo,
Scărlătescu Escaterina,
Hartmann Jan
Publication year - 2020
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16102
Subject(s) - thromboelastometry , hyperfibrinolysis , medicine , thromboelastography , coagulopathy , fibrinolysis , coagulation testing , thrombelastography , partial thromboplastin time , coagulation , intensive care medicine , surgery
The quantification of the coagulopathic state associated with oncologic and hematologic diseases is imperfectly assessed by common coagulation tests such as prothrombin time, activated partial thromboplastin time, fibrinogen levels, and platelet count. These tests provide a static representation of a component of hemostatic integrity, presenting an incomplete picture of coagulation in these patients. Viscoelastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), as whole blood analyses, provide data related to the cumulative effects of blood components and all stages of the coagulation and fibrinolytic processes. The utility of VETs has been demonstrated since the late 1960s in guiding blood component therapy for patients undergoing liver transplantation. Since then, the scope of viscoelastic testing has expanded to become routinely used for cardiac surgery, obstetrics, and trauma. In the past decade, VETs' expanded usage has been most significant in trauma resuscitation. However, use of VETs for patients with malignancy‐associated coagulopathy (MAC) and hematologic malignancies is increasing. For the purposes of this narrative review, we discuss the similarities between trauma‐induced coagulopathy (TIC) and MAC. These similarities center on the thrombomodulin‐thrombin complex as it switches between the thrombin‐activatable fibrinolysis inhibitor coagulation pathway and activating the protein C anticoagulation pathway. This produces a spectrum of coagulopathy and fibrinolytic alterations ranging from shutdown to hyperfibrinolysis that are common to TIC, MAC, and hematologic malignancies. There is expanding literature regarding the utility of TEG and ROTEM to describe the hemostatic integrity of patients with oncologic and hematologic conditions, which we review here.