Viscoelastic testing: Transforming hemostasis management in patients in the medical intensive care unit

Viscoelastic testing (VET) has emerged as a groundbreaking method for assessing hemostasis, offering real-time evaluations of coagulation dynamics that exceed traditional tests. It provides immediate insights into the complex interplay among plasma coagulation factors, platelets, and cellular components that regulate hemostatic function, offering a continuous evaluation of the entire hemostatic process - from initial clot formation and stabilization to dissolution. Although often utilized in surgical settings such as liver transplants, trauma, or cardiac surgery, VET has also proven valuable in medical intensive care units (ICUs). In non-surgical patients in the ICU, coagulopathy is common, and timely decision-making is critical. VET offers distinct advantages over conventional coagulation tests by providing rapid, point-of-care results that can guide targeted therapeutic interventions. VET-guided transfusion algorithms have reduced allogeneic transfusion rates by 20%-40%, shortened time to intervention by 30%-50% compared to conventional coagulation tests, and improved ICU length of stay. This review discusses VET's principles, limitations, clinical applications in medical ICUs, and the challenges of its implementation. Incorporating VET into routine clinical practice signifies a shift toward advanced, individualized hemostatic care, significantly enhancing patient safety and clinical outcomes while optimizing resource utilization in modern medical ICUs.