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Panelists on viscoelastic and other coag assays
January 2024—Viscoelastic assays and other coagulation tests were front and center when CAP TODAY publisher Bob McGonnagle on Nov. 20 convened seven people in an online roundtable. Oksana Volod, MD, and Eric Salazar, MD, PhD, and five company representatives weighed in on, among other things, appropriate test use, automation, and laboratory-developed tests. What they said begins here; CAP TODAY’s guide to coagulation analyzers begins here.
Oksana Volod, you have now written the first book on viscoelastic testing that’s designed to speak directly to pathologists and others in clinical laboratories. Where are we with the adoption of viscoelastic testing? Will it become more mainstream now in the repertoire of the people who do thrombosis and hemostasis testing?
Oksana Volod, MD, director of coagulation consultative service and professor of pathology, Cedars-Sinai Medical Center; associate professor of pathology, David Geffen School of Medicine at UCLA: TEG [thromboelastography], the first viscoelastic assay, was developed before partial thromboplastin time and was initially used in liver transplant and cardiac surgeries. In 2000, when we had a cell-based model of hemostasis, there was an understanding that there was a role for platelets, red blood cells, and other cells or elements to form a clot, and that plasma-based assays, like PTT and PT, will not provide comprehensive information. That’s when interest in viscoelastic testing emerged and when it was adopted, mainly by anesthesiologists, perfusionists, people who were in the OR. Laboratories were not that receptive because there were validation steps they would have to be involved in, and there was a disconnect at some point between laboratorians and anesthesiologists and surgeons. They wanted to bring viscoelastic assays in-house, but laboratories were resistant and questioned where the device would be located—in the laboratory or at the point of care. However, the laboratory was instrumental in validation and in maintaining the competency of their personnel. The whole process was a collaboration.
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