Scarlatescu E. Viscoelastic testing: Transforming hemostasis management in patients in the medical intensive care unit. World J Crit Care Med 2026; 15(1): 113889 [DOI: 10.5492/wjccm.v15.i1.113889]
Corresponding Author of This Article
Ecaterina Scarlatescu, MD, PhD, Assistant Professor, Consultant, Department of Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari 8, Bucharest 050474, Romania. ecaterina.scarlatescu@umfcd.ro
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Critical Care Medicine
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Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 9, 2026 (publication date) through Mar 3, 2026
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Scarlatescu E. Viscoelastic testing: Transforming hemostasis management in patients in the medical intensive care unit. World J Crit Care Med 2026; 15(1): 113889 [DOI: 10.5492/wjccm.v15.i1.113889]
World J Crit Care Med. Mar 9, 2026; 15(1): 113889 Published online Mar 9, 2026. doi: 10.5492/wjccm.v15.i1.113889
Viscoelastic testing: Transforming hemostasis management in patients in the medical intensive care unit
Ecaterina Scarlatescu
Ecaterina Scarlatescu, Department of Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
Ecaterina Scarlatescu, Department of Anesthesia and Intensive Care Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
Author contributions: Scarlatescu E conceived and designed the review, analyzed the data, and wrote the manuscript.
Conflict-of-interest statement: Scarlatescu E reports speaker fees from Werfen, CSL Behring Germany, Prisum Healthcare Romania, Vifor Pharma Romania, outside the submitted work.
Corresponding author: Ecaterina Scarlatescu, MD, PhD, Assistant Professor, Consultant, Department of Anesthesia and Intensive Care, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari 8, Bucharest 050474, Romania. ecaterina.scarlatescu@umfcd.ro
Received: September 5, 2025 Revised: September 26, 2025 Accepted: December 12, 2025 Published online: March 9, 2026 Processing time: 176 Days and 0.9 Hours
Abstract
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.
Core Tip: Viscoelastic testing (VET) provides rapid, whole-blood assessment of the entire coagulation process, offering a real-time and comprehensive evaluation that surpasses conventional coagulation tests in the medical intensive care unit. VET identifies hidden hypocoagulable and hypercoagulable states and fibrinolysis resistance, enabling targeted, precision-based therapies in diverse intensive care unit populations, including sepsis, coronavirus disease 2019, and liver disease. Despite technical and economic challenges, VET-guided management reduces unnecessary transfusions, optimizes resource utilization, and holds promise for integrating artificial intelligence to deliver individualized, advanced hemostatic care for patients who are critically ill.
