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

Sep 30, 2026

Trauma-induced coagulopathy (TIC) is characterized as an endogenous response to traumatic injury, shifting management toward early, physiologically based hemostatic resuscitation. Effective treatment centers on rapid recognition and correction of fibrinolysis and fibrinogen abnormalities, dysregulated thrombin generation, and platelet dysfunction. Viscoelastic hemostatic assays (VHAs) provide point-of-care, multi-parameter assessment of clot initiation, propagation, stabilization, and degradation, enabling goal-directed, individualized protocols. Evidence supporting improved key clinical outcomes versus conventional tests remains debated, prompting a narrative review of TIC pathophysiology, VHA strengths and limitations, and clinical application.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Introduction

Methods

Review Viscoelastic Hemostatic Assays in the Management of Trauma-Induced Coagulopathy: A Clinical Update Daniele Natalini 1,2, Rikardo Xhemalaj 1,2 and Simone Carelli 1,2, * Academic Editor: Carlo Finelli Received: 11 November 2025 Revised: 10 December 2025 Accepted: 13 December 2025 Published: 19 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; [daniele.natalini@policlinicogemelli.it](daniele.natalini@policlinicogemelli.it) (D.N.); [rikardoxhemalaj@gmail.com](rikardoxhemalaj@gmail.com) (R.X.) 2 Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy * Correspondence: [simone.carelli@policlinicogemelli.it](simone.carelli@policlinicogemelli.it) 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 singleuse 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. Keywords: trauma-induced coagulopathy; viscoelastic hemostatic assays; damage control resuscitation; hemostatic resuscitation 1. Introduction Coagulopathy is a pillar of life-threatening post-traumatic bleeding, combined with metabolic acidosis, hypothermia, and hypocalcemia in the “diamond of death”. Uncontrolled hemorrhage may account for up to 25% of injury-related deaths, many of them having a coagulopathic component; similarly, more than 30% of severe trauma patients admitted to the emergency department are in a coagulopathic state [1] . Trauma-induced coagulopathy (TIC) refers to the evolving patterns of hemostatic derangements attributable to trauma; while the immediate post-traumatic hours are characterized by a profile of hypocoagulability resulting in a bleeding phenotype (early TIC), a dynamic and progressive transition to a subsequent phase of hypercoagulable state occurs, with an increased risk of thrombotic events (late TIC) . Prompt characterization of the underlying hemostatic disorders represents a cornerstone in the treatment of coagulopathic trauma patients, augmenting damage control resuscitation [2] . Viscoelastic hemostatic assays (VHAs) are point-of-care tools that may provide, in a few minutes, quantitative and qualitative assessments of the phases of clot initi

FAQs

How is trauma-induced coagulopathy (TIC) defined in the review?

TIC refers to evolving hemostatic derangements caused by trauma. It transitions from early hypocoagulability with bleeding phenotype to later hypercoagulability with higher thrombotic risk.

What do viscoelastic hemostatic assays (VHAs) measure?

VHAs provide rapid point-of-care assessment of clot initiation, propagation, stabilization, and degradation, including quantitative information on fibrinolysis and the specific contribution of fibrinogen.

Do guidelines recommend VHA-based strategies for trauma patients?

Current guidelines support goal-directed strategies that include viscoelastic testing to guide hemostatic resuscitation and optimize transfusion load.

Sep 30, 2026

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