Hamostaseologie 2025; 45(01): 024-048
DOI: 10.1055/a-2491-3631
Review Article

Guidance-Based Appropriateness of Hemostasis Testing in the Acute Setting

Luigi Devis
1   Namur Laboratory Appropriateness and Sustainability Team (LAST), CHU UCL Namur, UCLouvain, Belgium
,
Deepa J. Arachchillage
2   Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
3   Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
,
Michael Hardy
1   Namur Laboratory Appropriateness and Sustainability Team (LAST), CHU UCL Namur, UCLouvain, Belgium
4   Department of Laboratory Medicine, CHU UCL Namur, UCLouvain, Belgium
5   Department of Anesthesiology, CHU UCL Namur, UCLouvain, Belgium
,
Alexandre Mansour
6   Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
7   Research Institute for Environmental and Occupational Health (IRSET), University of Rennes, Rennes, France
,
Emilie Catry
1   Namur Laboratory Appropriateness and Sustainability Team (LAST), CHU UCL Namur, UCLouvain, Belgium
4   Department of Laboratory Medicine, CHU UCL Namur, UCLouvain, Belgium
,
Mélanie Closset
1   Namur Laboratory Appropriateness and Sustainability Team (LAST), CHU UCL Namur, UCLouvain, Belgium
4   Department of Laboratory Medicine, CHU UCL Namur, UCLouvain, Belgium
8   Insitute of Experimental and Clinical Research (IREC), UCLouvain, Belgium
,
Isabelle Gouin-Thibault
7   Research Institute for Environmental and Occupational Health (IRSET), University of Rennes, Rennes, France
9   Department of Hematology, Pontchaillou, University Hospital of Rennes, Rennes, France
,
Corinne Frere
10   Department of Hematology, Pitié-Salpêtrière Hospital, Sorbonne Université, Assistance-Publique-Hôpitaux de Paris, F-75013 Paris, France
,
Thomas Lecompte
11   Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, UCLouvain, Belgium
12   Division of Angiology, Université de Lorraine CHRU Nancy, Nancy, France
,
Lorenzo Alberio
13   Division of Haematology and Central Haematology Laboratory, CHUV, UNIL, Lausanne, Switzerland
,
Janne Cadamuro
14   Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
,
Giuseppe Lippi
15   Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
,
François Mullier
1   Namur Laboratory Appropriateness and Sustainability Team (LAST), CHU UCL Namur, UCLouvain, Belgium
4   Department of Laboratory Medicine, CHU UCL Namur, UCLouvain, Belgium
8   Insitute of Experimental and Clinical Research (IREC), UCLouvain, Belgium
11   Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, UCLouvain, Belgium
› Institutsangaben

Abstract

In this review, we aim to highlight the extent of inappropriate hemostasis testing and provide practical guidance on how to prevent it. We will focus on the acute setting, including but not limited to the emergency department and intensive care unit. To this end, we will first discuss the significance of inappropriateness, in the general context of laboratory medicine. This includes acknowledging the importance of the phenomenon and attempting to define it. Next, we describe the harmful consequences of inappropriate testing. Finally, we focus on the inappropriate use of hemostasis testing in the acute setting. The second section describes how interventions―in particular, the implementation of guidance for testing—can efficiently reduce inappropriateness. In the third section, we summarize the available recommendations for rational use of hemostasis testing (platelet count, activated partial thromboplastin time, prothrombin time/international normalized ratio, fibrinogen, thrombin time, D-dimer, anti-Xa assay, antithrombin, ADAMTS13 activity, antiheparin-PF4 antibodies, viscoelastometric tests, coagulation factors, and platelet function testing), as supported by guidelines, recommendations, and/or expert opinions. Overall, this review is intended to be a toolkit in the effort to promote the appropriate use of hemostasis testing. Hopefully, the new In Vitro Diagnostic Medical Device Regulation (EU) 2017/746 (IVDR) should help in improving the availability of evidence regarding clinical performance of hemostasis assays.

Authors' Contribution

L.D. and F.M. contributed to the design of the manuscript. L.D. and F.M. drafted the manuscript and tables. D.J.A., M.H., A.M., E.C., M.C., I.G-T., C.F., T.L., L.A., J.C., G.L., and F.M. substantially revised and enhanced the manuscript. All authors approved the final version of the manuscript.




Publikationsverlauf

Eingereicht: 17. Oktober 2024

Angenommen: 02. Dezember 2024

Artikel online veröffentlicht:
19. Februar 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
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