# Viscoelastic Hemostatic Assays in the Management of Trauma-Induced Coagulopathy: A Clinical Update

## TL;DR

This paper reviews the use of viscoelastic hemostatic assays in managing trauma-induced coagulopathy, focusing on their role in guiding personalized resuscitation strategies.

## Contribution

The paper provides a narrative review on the evolving role of viscoelastic hemostatic assays in trauma care and their clinical implications.

## Key findings

- Viscoelastic hemostatic assays can rapidly assess clot formation and identify coagulation abnormalities.
- Their use in guiding transfusion strategies is supported by current guidelines but remains debated due to mixed clinical outcomes.
- The paper highlights the strengths and limitations of these assays in trauma-induced coagulopathy management.

## Abstract

The recognition of trauma-induced coagulopathy (TIC) as an endogenous response to traumatic injuries rather than a consequence of therapeutic interventions has shifted the clinical approach toward an early and physiologically based hemostatic resuscitation. Prompt identification and correction of fibrinolysis and fibrinogen level derangements, dysregulated thrombin generation, and platelet dysfunction represent the cornerstones of the treatment strategies. Currently available viscoelastic hemostatic assays (VHAs) are point-of-care devices able to rapidly assess the phases of clot initiation, propagation, stabilization, and degradation, as well as isolate the contribution of specific elements—e.g., fibrinogen—to the coagulation process in fully automated analyses by multi-channel single-use cartridges. As a result, in the last decade, VHAs have been widely investigated as tools to implement individualized protocols of hemostatic resuscitation. Current guidelines support their use to optimize transfusion load in a goal-directed strategy. Nevertheless, contrasting evidence has emerged regarding the improvement in main clinical outcomes induced by the VHA-based algorithm of hemostatic resuscitation compared with those guided by conventional coagulation tests, and their place in the management of this peculiar population is still a matter of debate. We propose a narrative review ranging from TIC physiopathology as a proper substrate for viscoelastic diagnostic technique, through the strengths and weaknesses of VHAs, to their application in clinical practice.