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Semin Thromb Hemost 2010; 36(7): 693-694
DOI: 10.1055/s-0030-1265284
FOREWORD

© Thieme Medical Publishers

Global Hemostasis: New Approaches to Patient Diagnosis and Treatment Monitoring

Emmanuel J. Favaloro1
  • 1Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, SWAHS, Westmead, NSW, Australia
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Publication History

Publication Date:
26 October 2010 (online)

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Welcome to another issue of Seminars in Thrombosis and Hemostasis. In this issue, Maha Othman has put together an interesting collection of articles that reviews the topic of global hemostasis. The concept of global hemostasis is certainly not new. As the name implies, global hemostasis assays are intended to assess the risk of bleeding, thrombosis, fibrinolysis, and response to antithrombotics in various clinical conditions using a single assay, typically performed on whole blood.

One of the methodologies used for global hemostasis highlighted in the current issue is thromboelastography (TEG), which has a long history (as briefly reviewed here by Wegner and Popovsky[1] and by Othman et al[2]). It was first described in 1948, >60 years ago. The methodology was introduced as a tool for the management of acute bleeding in liver transplantation and cardiac surgery in the 1980s. Other uses for TEG were explored between the 1980s and early 1990s, and the mid to late 1990s saw an intensive use in trauma and in obstetrics, monitoring coagulopathy in preeclampsia and other pregnancy complications.[2] Nevertheless, most studies exploring the benefit of TEG measurements compared with standard coagulation tests were in anesthesia and trauma patients. Today, the technology is finding additional utility in a broad range of applications, as highlighted by several articles in this issue.

Like many early tests of hemostasis, a more broad-based acceptance of TEG from its early beginnings required improved methodologies and user-friendly instrumentation. Today, two instrument driven methodologies that appear to dominate for clinical use are the TEG (Thromboelastograph; Haemoscope Corp., Niles, IL, USA) and the ROTEM (Rotation Thromboelastometer; Pentapharm GmbH, Munich, Germany). Because the ROTEM is not approved by the Food and Drug Administration for use in the United States, the relative utility of TEG versus ROTEM may be geographically based. However, a broader acceptance of this methodology requires better standardization and evidence of broader comparability, as highlighted in this issue by Chitlur and Lusher[3] and Kitchen et al.[4] Seminars in Thrombosis and Hemostasis last featured TEG in a supplement in 1995.[5] Thus the inclusion of TEG within a current issue is certainly timely.

Other tests and concepts of global hemostasis are also explored, including the overall hemostasis potential (OHP) and thrombin generation.[6] [7] [8] The concept and topic of thrombin generation has been selectively explored within several previous issues of Seminars in Thrombosis and Hemostasis over the past decade.[9] [10] [11] [12] [13] [14]

I would like to thank Maha Othman for putting together this interesting update of global hemostasis, and I hope that our readers enjoy its many treasures. Professor Othman has recently joined us an associate editor. She last guest edited an issue of Seminars in Thrombosis and Hemostasis in 2008 on molecular genetic testing in hemostasis and thrombosis.[15]

REFERENCES

Emmanuel J FavaloroPh.D. M.A.I.M.S. 

Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR)

Westmead Hospital, WSAHS, Westmead, NSW 2145, Australia

Email: emmanuel.favaloro@swahs.health.nsw.gov.au

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