Connect Sign InViscoelastic and Conventional Testing for Bleeding Assessments
Effective management of major bleeding—such as that encountered in severe trauma, cardiac surgery with cardiopulmonary bypass, and postpartum hemorrhage—requires timely identification and correction of coagulopathy through appropriate coagulation monitoring. In these high-risk settings, goal-directed therapy informed by either standard laboratory assays (e.g., PT/INR, aPTT, platelet count, and fibrinogen levels) or viscoelastic point-of-care testing (e.g., TEG or ROTEM) enables individualized and efficient hemostatic management. Viscoelastic testing provides real-time insights into clot formation, strength, and fibrinolysis, supporting targeted administration of blood products and factor concentrates, including prothrombin complex and fibrinogen concentrates. This approach helps reduce transfusions, supports hemostatic stability, and can improve patient outcomes. This presentation will review key principles of coagulation monitoring, compare standard and viscoelastic testing modalities, and discuss their incorporation into bleeding management algorithms across a range of clinical scenarios.
Nathaniel Birgenheier, MD is a board-certified anesthesiologist who practices cardiac and general anesthesia at the University of Utah. He is an Associate Professor of Anesthesiology who additionally specializes in intraoperative echocardiography and has a special interest in PBM and viscoelastic testing. As one of the only anesthesiologists in the country to hold a CLIA license, Dr. Birgenheier was responsible for bringing ROTEM to the University of Utah and has made extensive efforts to educate members of the anesthesiology department, all surgical subspeciality groups and staff members of the surgical and cardiothoracic ICUs in the appropriate use and interpretation of viscoelastic tests. He enjoys collaborating with other stakeholders in PBM including members of the Pathology, Blood Banking, and Clinical Laboratories. In addition, Dr. Birgenheier serves as a consultant to Werfen in an effort to make viscoelastic testing more approachable and useful.
Jerrold H Levy, MD, FAHA, FCCM, is a professor of anesthesiology, critical care, and surgery (cardiothoracic) at Duke University Medical Center in Durham, NC. He is currently vice chair of the Scientific and Standardization Committee of the International Society of Thrombosis and Hemostasis and former Chair of the Perioperative and Critical Care Committee. He obtained his medical degree from the University of Miami, where he was a resident in internal medicine, followed by an Anesthesiology residency at the Massachusetts General Hospital/Harvard Medical School, where he was Chief Resident, and completed fellowships in Respiratory ICU and Cardiac Anesthesiology. Before Duke, he was Professor and Deputy Chair for Research at Emory University School of Medicine. Dr Levy is an Associate Editor for the Journal of Thrombosis and Haemostasis, previously Executive Editor for Anesthesiology, and on the Editorial Board for the Journal of Thoracic and Cardiovascular Surgery. His current clinical and research interests include anticoagulation and its reversal, therapeutic strategies to prevent and treat coagulopathy and acute inflammation in critically ill patients and extracorporeal life support, applications of recombinant and purified protein concentrates for treating coagulopathy, bleeding, and anaphylaxis. He is the author of over 550 publications on PubMed with an h-index of 108 and i10-index of 465. He is also fluent in French and conversational in Spanish and Japanese.
