Viscoelastic Testing for Coagulation Management in Vascular Surgery-A Narrative Review.

Background: Viscoelastic testing (VET) has been increasingly used in cardiac, trauma, and hepatic surgery where it helps tackle the development of complex coagulopathies. Despite this, data on using VETs in vascular surgery remains limited to small and non-randomised control studies. Although the improvement in vascular techniques has decreased the rate of massive haemorrhages, there remain situations where they are a serious risk, and the associated coagulopathies pose a challenge to manage. Aims: The aim of this paper is to review the current approved uses of VET and its potential translational benefit in vascular surgery. Methods: An initial PUBMED search provided the foundation for chain sampling to identify relevant papers. Results: With VET, clinicians can rapidly assess a patient's global haemostatic function thus allowing the timely, or pre-emptive, correction of coagulopathies. Using the platelet analysis functions pre-operatively helps guide anaesthetic technique as well as temporary discontinuation of anti-platelet therapy, an almost ubiquitous drug among vascular patients. Intra-operatively, the use of this point-of-care test, along with goal-directed algorithms, reduces the volumes of platelets, fibrinogen, and plasma that are transfused. During recovery, using VET can help distinguish a coagulopathic bleed from one requiring surgical re-exploration. Besides reducing the well-established adverse effects of transfusions, from electrolyte disturbances to the more rare but severe graft-vs-host disease, there is a significant cost-reducing effect. Conclusions: Although there is limited evidence of VET in vascular surgery, there seems to be a clear benefit from its use warranting further large randomised controlled trials from which standardised guidelines can be produced.