Thromboelastography and multiplate tests for current rotational left ventricular assist device management.

Early ROTEM- and TEG-guided transfusion algorithms are horizontally organized; the order in which abnormalities are identified and treated is not defined and the interdependence of coagulation is not addressed.4,8 However, the current algorithms are vertically organized and define a sequence of interventions based on ROTEM and TEG analyses, as well as clinical observations that address the multifactorial nature of the perioperative coagulopathies. Keywords: anticoagulation; left ventricular assist device; multiplate; thromboelastography EN anticoagulation left ventricular assist device multiplate thromboelastography 2629 2632 4 08/03/22 20220901 NES 220901 Bleeding and thromboembolic events still negatively impact the outcomes of patients with ventricular assist devices (VADs).1-3 Over 150 years ago, the German pathologist, Rudolf Virchow, postulated that thrombus formation and propagation reflected abnormalities in blood flow, vessel walls, and blood components.3 These three factors are known as Virchow's triad, which is characterized by hemorheological abnormalities and turbulence at vessel bifurcations and in stenotic regions; endothelial abnormalities such as atherosclerosis and the associated vascular inflammation; and abnormalities in coagulation and fibrinolytic pathways. The turnaround times of standard laboratory tests (PT, aPTT, fibrinogen concentration, and platelet count) are generally considered too long (45-60 min in some cases) to guide hemostatic therapy in severely bleeding patients, whereas meaningful ROTEM and MEA measurements are available within 15-20 min. [Extracted from the article]