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Clinical Applications, Pitfalls, and Uncertainties of Thrombin Generation in the Presence of Platelets
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Sensitivity of Viscoelastic Tests to Platelet Function

Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
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J. Clin. Med. 2020, 9(1), 189; https://doi.org/10.3390/jcm9010189
Received: 9 December 2019 / Revised: 28 December 2019 / Accepted: 7 January 2020 / Published: 10 January 2020
Viscoelastic tests provide a dynamic assessment of coagulation, by exploring the time to clot formation and the clot strength. Using specific activators or inhibitors, additional factors can be explored, like the fibrinogen contribution to clot strength. Since the early days, various attempts have been done to measure platelet function with viscoelastic test. In general, the difference between the maximum clot strength and the fibrinogen contribution is considered an index of platelet contribution. However, this parameter does not clearly split platelet count from function; additionally, the extensive thrombin generation of standard activated viscoelastic tests activates platelet through the protease activated receptors, bypassing the other pathways. For this reason, standard viscoelastic tests cannot be used to assess platelet reactivity under the effects of aspirin or P2Y12 inhibitors. To overcome this limitation, a specific test was developed (thromboelastography platelet mapping). This test has been compared with the gold standard of light transmission aggregometry and with other point-of-care tests, with conflicting results. In general, the use of viscoelastic tests to assess the effects of antiplatelet agents is still limited. Conversely, platelet contribution to clot strength in the setting of coagulopathic bleeding is considered an important parameter to trigger platelet transfusion or desmopressin. View Full-Text
Keywords: platelets; platelet function tests; viscoelastic methods platelets; platelet function tests; viscoelastic methods
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Ranucci, M.; Baryshnikova, E. Sensitivity of Viscoelastic Tests to Platelet Function. J. Clin. Med. 2020, 9, 189.

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