• Patrick D Tyler, Lauren M Yang, Samuel B Snider, Adam B Lerner, William C Aird, and Nathan I Shapiro.
• Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: ptyler1@bidmc.harvard.edu.
• Ann Emerg Med. 2021 Mar 1; 77 (3): 357-366.

AbstractPatients frequently visit the emergency department with conditions that place them at risk of worse outcomes when accompanied by coagulopathy. Routine tests of coagulation-prothrombin time, partial thromboplastin time, platelets, and fibrinogen-have shortcomings that limit their use in providing emergency care. One alternative is to investigate coagulation disturbance with viscoelastic monitoring (VEM), a coagulation test that measures the timing and strength of blood clot development in real time. VEM is widely used and studied in cardiac surgery, liver transplant surgery, anesthesia, and trauma. In this article, we review the technique of VEM and the biologic rationale of using it in addition to routine tests of coagulation in emergency clinical situations. Then, we review the evidence (or lack thereof) for using VEM in the diagnosis and treatment of specific conditions. Finally, we describe the limitations of the test and future directions for clinical use and research in emergency medicine.Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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