{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:52:52Z","timestamp":1760151172388,"version":"build-2065373602"},"reference-count":81,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T00:00:00Z","timestamp":1645315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In the field of otolaryngology\u2014head and neck surgery (ENT), coagulopathies present unique diagnostic and therapeutic challenges. In both hyper- and hypocoagulable patients, management of coagulopathies requires intricate attention to the nature of hemostatic competence. Common coagulation tests (CCTs) offer only a snapshot of hemostatic competence and do not provide a clear insight into the patient\u2019s real-time hemostatic condition. Viscoelastic tests (VETs) offer a holistic and concurrent picture of the coagulation process. Although VETs have found prominent utilization in hepatic transplants, obstetrics, and emergent surgical settings, they have not been fully adopted in the realm of otolaryngology. The objective of this manuscript is to provide an overview of the literature evaluating the current utilization and possible future uses of VETs in the field of otolaryngology. The authors performed a comprehensive literature search of the utilization of VETs in otolaryngology and identified applicable studies that included descriptions of viscoelastic testing. Twenty-five studies were identified in this search, spanning topics from head and neck oncology, microvascular free flap reconstruction, obstructive sleep apnea, adenotonsillectomy, facial trauma, and epistaxis. The applicability of VETs has been demonstrated in head and neck oncology and microvascular free flap management, although their pervasiveness in practice is limited. Underutilization of VETs in the field of otolaryngology may be due to a lack of familiarity of the tests amongst practitioners. Instead, most otolaryngologists continue to rely on CCTs, including PT, PTT, INR, CBC, fibrinogen levels, and thrombin time. Learning to perform, interpret, and skillfully employ VETs in clinical and operative practice can greatly improve the management of coagulopathic patients who are at increased risk of bleeding or thrombosis.<\/jats:p>","DOI":"10.3390\/jcm11041119","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T08:22:19Z","timestamp":1645431739000},"page":"1119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Use of Thromboelastography and Rotational Thromboelastometry in Otolaryngology: A Narrative Review"],"prefix":"10.3390","volume":"11","author":[{"given":"Mathew K.","family":"Marsee","sequence":"first","affiliation":[{"name":"Department of Graduate Medical Education, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal S.","family":"Shariff","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1561-6161","authenticated-orcid":false,"given":"Grant","family":"Wiarda","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Watson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali H.","family":"Sualeh","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5970-9730","authenticated-orcid":false,"given":"Toby J.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Indiana Wesleyan University, Marion, IN 46953, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2143-7944","authenticated-orcid":false,"given":"Max L.","family":"McCoy","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamid D.","family":"Al-Fadhl","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Indiana University Bloomington, Bloomington, IN 47405, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9219-285X","authenticated-orcid":false,"given":"Alexander J.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick K.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Foundation, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Folsom","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,20]]},"reference":[{"key":"ref_1","first-page":"7","article-title":"Hemostatic management of patients undergoing ear-nose-throat surgery","volume":"14","author":"Thiele","year":"2015","journal-title":"GMS Curr. Top Otorhinolaryngol. Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4699","DOI":"10.1182\/blood-2012-05-423228","article-title":"Perioperative management of patients on chronic antithrombotic therapy","volume":"120","author":"Ortel","year":"2012","journal-title":"Blood"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1213\/00000539-198509000-00008","article-title":"Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation","volume":"64","author":"Kang","year":"1985","journal-title":"Anesth. Analg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1213\/00000539-199902000-00016","article-title":"Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery","volume":"88","author":"Manspeizer","year":"1999","journal-title":"Anesth. Analg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1055\/s-0040-1702171","article-title":"Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography","volume":"46","author":"Hartmann","year":"2020","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Farrell, M.S., Moore, E.E., Thomas, A.V., Coleman, J.R., Thomas, S., Vande Lune, S., Marconi, T., Cohen, M.J., Chapman, M.P., and Moore, H.B. (2021). \u201cDeath Diamond\u201d Tracing on Thromboelastography as a Marker of Poor Survival After Trauma. Am. Surg.","DOI":"10.1177\/0003134821998684"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Simurda, T., Asselta, R., Zolkova, J., Brunclikova, M., Dobrotova, M., Kolkova, Z., Loderer, D., Skornova, I., Hudecek, J., and Lasabova, Z. (2021). Congenital Afibrinogenemia and Hypofibrinogenemia: Laboratory and Genetic Testing in Rare Bleeding Disorders with Life-Threatening Clinical Manifestations and Challenging Management. Diagnostics, 11.","DOI":"10.3390\/diagnostics11112140"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0165-5876(96)01364-X","article-title":"Post-tonsillectomy hemorrhage: An assessment of risk factors","volume":"37","author":"Myssiorek","year":"1996","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s00106-007-1585-x","article-title":"Risk of hemorrhage after adenoidectomy and tonsillectomy. Value of the preoperative determination of partial thromboplastin time, prothrombin time and platelet count","volume":"56","author":"Scheckenbach","year":"2008","journal-title":"HNO"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1055\/s-2007-966977","article-title":"Significance of blood tests prior to adenoidectomy","volume":"87","author":"Schwaab","year":"2008","journal-title":"Laryngorhinootologie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-2004-818789","article-title":"Preoperative coagulation screening prior to adenoidectomy and tonsillectomy","volume":"217","author":"Eberl","year":"2005","journal-title":"Klinische Padiatrie"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0165-5876(01)00574-2","article-title":"The need for routine pre-operative coagulation screening tests (prothrombin time PT\/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and\/or adenoidectomy","volume":"61","author":"Asaf","year":"2001","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/ans.15557","article-title":"Randomized controlled trials and Cochrane analyses versus precision-based medicine for tranexamic acid and viscoelastic testing in trauma","volume":"90","author":"Walsh","year":"2020","journal-title":"ANZ J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1055\/s-0030-1265288","article-title":"Critical factors contributing to the thromboelastography trace","volume":"36","author":"MacDonald","year":"2010","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-021-00264-3","article-title":"Trauma-induced coagulopathy","volume":"7","author":"Moore","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"516","DOI":"10.4103\/0971-9784.185546","article-title":"Simulation in coagulation testing using rotational thromboelastometry: A fast emerging, reliable point of care technique","volume":"19","author":"Gorlinger","year":"2016","journal-title":"Ann. Card. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Moore, H.B., Moore, E.E., and Neal, M.D. (2021). Rotational Thromboelastometry (ROTEM\u00ae). Trauma Induced Coagulopathy, Springer Nature. [2nd ed.].","DOI":"10.1007\/978-3-030-53606-0"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.thromres.2020.01.024","article-title":"Perioperative management of a severe congenital hypofibrinogenemia with thrombotic phenotype","volume":"188","author":"Simurda","year":"2020","journal-title":"Thromb. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/bjh.15524","article-title":"The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline","volume":"182","author":"Curry","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Walsh, M., Moore, E.E., Moore, H.B., Thomas, S., Kwaan, H.C., Speybroeck, J., Marsee, M., Bunch, C.M., Stillson, J., and Thomas, A.V. (2021). Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020320"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1177\/0310057X1604400417","article-title":"Thromboelastometry and thromboelastography failed to detect hypercoagulability in thrombotic microangiopathy","volume":"44","author":"Harahsheh","year":"2016","journal-title":"Anaesth. Intensive Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1097\/TA.0000000000002944","article-title":"Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma","volume":"89","author":"Bugaev","year":"2020","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bareille, M., Hardy, M., Douxfils, J., Roullet, S., Lasne, D., Levy, J.H., St\u00e9panian, A., Susen, S., Fr\u00e8re, C., and Lecompte, T. (2021). Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081740"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.tmrv.2011.07.005","article-title":"Principles and practice of thromboelastography in clinical coagulation management and transfusion practice","volume":"26","author":"Bolliger","year":"2012","journal-title":"Transfus. Med. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sahli, S.D., R\u00f6ssler, J., Tscholl, D.W., Studt, J.-D., Spahn, D.R., and Kaserer, A. (2020). Point-of-care diagnostics in coagulation management. Sensors, 20.","DOI":"10.3390\/s20154254"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/ACO.0000000000000278","article-title":"Fixed ratio versus goal-directed therapy in trauma","volume":"29","author":"Maegele","year":"2016","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1161\/CIRCULATIONAHA.113.002283","article-title":"Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: A randomized, plasma-controlled, phase IIIb study","volume":"128","author":"Sarode","year":"2013","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/s00106-014-2843-3","article-title":"ENT surgery in patients with anticoagulants and platelet aggregation inhibitors","volume":"62","author":"Knopf","year":"2014","journal-title":"HNO"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.thromres.2014.05.015","article-title":"Bleeding complications in patients with coronary stents during non-cardiac surgery","volume":"134","author":"Albaladejo","year":"2014","journal-title":"Thromb. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1017\/S0022215112001545","article-title":"Antiplatelet drugs in elective ENT surgery","volume":"126","author":"Savage","year":"2012","journal-title":"J. Laryngol. Otol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Moore, H.B., Moore, E.E., and Neal, M.D. (2021). Thromboelastography (TEG\u00ae 5000 and TEG\u00ae 6s Hemostasis Analyzers with TEG Manager\u00ae Software). Trauma Induced Coagulopathy, Springer Nature. [2nd ed.].","DOI":"10.1007\/978-3-030-53606-0"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Moore, H.B., Moore, E.E., and Neal, M.D. (2021). Plasma Transfusion. Trauma Induced Coagulopathy, Springer Nature. [2nd ed.].","DOI":"10.1007\/978-3-030-53606-0"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/TA.0000000000002357","article-title":"Rapid point-of-care detection and classification of direct-acting oral anticoagulants with the TEG 6s: Implications for trauma and acute care surgery","volume":"87","author":"Dias","year":"2019","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jemermed.2020.04.009","article-title":"Tracing the Lines: A Review of Viscoelastography for Emergency Medicine Clinicians","volume":"59","author":"Gilbert","year":"2020","journal-title":"J. Emerg. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.bpa.2009.09.009","article-title":"Perioperative coagulation monitoring","volume":"24","year":"2010","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1055\/s-0039-1688497","article-title":"Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review","volume":"45","author":"Walsh","year":"2019","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/MBC.0b013e328363ab86","article-title":"Hemeoxygenase-1 mediated hypercoagulability in a patient with thyroid cancer","volume":"24","author":"Nielsen","year":"2013","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1055\/a-0723-3295","article-title":"Altered TEG Parameters Identify Hypercoagulablilty and are of Diagnosis Value for Papillary Thyroid Carcinoma Patients","volume":"128","author":"Lu","year":"2020","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1093\/bja\/86.1.94","article-title":"Comparison of coagulation and blood loss during anaesthesia with inhaled isoflurane or intravenous propofol","volume":"86","author":"Law","year":"2001","journal-title":"Br. J. Anaesth."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Durila, M., Lukas, P., Astraverkhava, M., Berousek, J., Zabrodsky, M., and Vymazal, T. (2015). Tracheostomy in intensive care unit patients can be performed without bleeding complications in case of normal thromboelastometry results (EXTEM CT) despite increased PT-INR: A prospective pilot study. BMC Anesthesiol., 15.","DOI":"10.1186\/s12871-015-0073-1"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"556","DOI":"10.3171\/2015.3.PEDS14663","article-title":"Use of blood-sparing surgical techniques and transfusion algorithms: Association with decreased blood administration in children undergoing primary open craniosynostosis repair","volume":"16","author":"Nguyen","year":"2015","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_42","first-page":"85","article-title":"Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome","volume":"7","author":"Ketelaars","year":"2016","journal-title":"A&A Case Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2766","DOI":"10.1007\/s00464-015-4549-3","article-title":"Impact of artificial capnothorax on coagulation in patients during video-assisted thoracoscopic esophagectomy for squamous cell carcinoma","volume":"30","author":"Mao","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/pan.13140","article-title":"An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery","volume":"27","author":"Mogensen","year":"2017","journal-title":"Paediatr. Anaesth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.bjoms.2004.08.024","article-title":"Thromboelastographic study of the effect of manipulation of central veins on coagulability of venous blood","volume":"43","author":"Mitchell","year":"2005","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1002\/micr.21978","article-title":"Functional fibrinogen to platelet ratio using thromboelastography as a predictive parameter for thrombotic complications following free tissue transfer surgery: A preliminary study","volume":"32","author":"Parker","year":"2012","journal-title":"Microsurgery"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1016\/j.bjps.2012.11.032","article-title":"Reconstruction of an extensive peri-orbital defect secondary to mucormycosis in a patient with myelodysplasia","volume":"66","author":"Murphy","year":"2013","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/micr.22199","article-title":"Can rotational thromboelastometry predict thrombotic complications in reconstructive microsurgery?","volume":"34","author":"Kolbenschlag","year":"2014","journal-title":"Microsurgery"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/MOO.0000000000000192","article-title":"Evaluating risk factors and predicting complications in head and neck reconstructive surgery","volume":"23","author":"Fuller","year":"2015","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.jcms.2015.05.016","article-title":"Thromboelastometry: A contribution to perioperative free-flap management","volume":"43","author":"Wikner","year":"2015","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"98","DOI":"10.5152\/TJAR.2019.07752","article-title":"Effect of Coagulation Status and Co-Morbidity on Flap Success and Complications in Patients with Reconstructed Free Flap","volume":"47","author":"Ekin","year":"2019","journal-title":"Turk. J. Anaesthesiol. Reanim."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"289","DOI":"10.3389\/fmed.2020.00289","article-title":"Thromboelastometry for Assessing Risks of Free Flap Thrombosis in Patients Undergoing Microvascular Surgery","volume":"7","author":"Vanags","year":"2020","journal-title":"Front. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.resp.2010.01.010","article-title":"Repeated inspiratory occlusions in anesthetized rats acutely increase blood coagulability as assessed by thromboelastography","volume":"171","author":"Othman","year":"2010","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.resp.2012.06.022","article-title":"CPAP reduces hypercoagulability, as assessed by thromboelastography, in severe obstructive sleep apnoea","volume":"183","author":"Toukh","year":"2012","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e008808","DOI":"10.1161\/JAHA.118.008808","article-title":"Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients with Acute Coronary Syndrome Taking Dual Antiplatelet Therapy","volume":"7","author":"Gong","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_56","unstructured":"Fern\u00e1ndez-Bello, I., Monz\u00f3n Manzano, E., Garc\u00eda R\u00edo, F., Justo Sanz, R., Cubillos-Zapata, C., Casitas, R., S\u00e1nchez, B., Jaureguizar, A., Acu\u00f1a, P., and Alonso-Fern\u00e1ndez, A. (2020). Procoagulant State of Sleep Apnea Depends on Systemic Inflammation and Endothelial Damage. Arch. Bronconeumol., in press."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1111\/j.1460-9592.2007.02268.x","article-title":"Sequential clot strength analyses following diclofenac in pediatric adenotonsillectomy","volume":"17","author":"Heaney","year":"2007","journal-title":"Paediatr. Anaesth."},{"key":"ref_58","first-page":"67","article-title":"Thromboelastography to guide the decision making in transfusion therapy in post-tonsillectomy bleeding secondary to pseudoaneurysm","volume":"32","author":"Amaya","year":"2009","journal-title":"Revista Mexicana de Anestesiolog\u00eda"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"S64","DOI":"10.1055\/s-0037-1619753","article-title":"Patients with isolated prolonged in vitro bleeding time. Clinical symptoms","volume":"31","author":"Alesci","year":"2011","journal-title":"Hamostaseologie"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/MBC.0b013e32835553c0","article-title":"Rotational thromboelastometry analysis and management of life-threatening haemorrhage in isolated craniofacial injury","volume":"23","author":"Grassetto","year":"2012","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.wem.2020.08.003","article-title":"Hematotoxic Snakebite Victim with Trauma: The Role of Guided Transfusion, Rotational Thromboelastometry, and Tranexamic Acid","volume":"31","author":"Abraham","year":"2020","journal-title":"Wilderness Environ. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1213\/ane.0b013e318168b367","article-title":"Coagulation monitoring: Current techniques and clinical use of viscoelastic point-of-care coagulation devices","volume":"106","author":"Ganter","year":"2008","journal-title":"Anesth. Analg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1002\/rth2.12114","article-title":"Preoperative screening for bleeding disorders: A comprehensive laboratory assessment of clinical practice","volume":"2","author":"Vries","year":"2018","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/j.1365-2141.2007.06968.x","article-title":"Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures","volume":"140","author":"Chee","year":"2008","journal-title":"Br. J. Haematol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1111\/j.1537-2995.2005.00546.x","article-title":"Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: An evidence-based review","volume":"45","author":"Segal","year":"2005","journal-title":"Transfusion"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3801","DOI":"10.1002\/cncr.24416","article-title":"Increasing incidence of differentiated thyroid cancer in the United States, 1988\u20132005","volume":"115","author":"Chen","year":"2009","journal-title":"Cancer"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Thromboembolic Risk Factors (THRIFT) Consensus Group (1992). Risk of and prophylaxis for venous thromboembolism in hospital patients. Br. Med. J., 305, 567\u2013574.","DOI":"10.1136\/bmj.305.6853.567"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1001\/jamaoto.2013.4911","article-title":"Prospective study of venous thromboembolism in patients with head and neck cancer after surgery","volume":"139","author":"Clayburgh","year":"2013","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_69","unstructured":"Braunwald, E.M.D., Zipes, D.P., Libby, P., and Bonow, R.O. (2015). Braunwald\u2019s Heart Disease: A Textbook of Cardiovascular Medicine, Morrow."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamaoto.2017.1367","article-title":"Association between hypercoagulability and severe obstructive sleep apnea","volume":"143","author":"Hong","year":"2017","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0165-5876(02)00396-8","article-title":"Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy","volume":"67","author":"Prim","year":"2003","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1097\/TA.0000000000002589","article-title":"Review of facial trauma management","volume":"88","author":"Choi","year":"2020","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.csm.2016.11.003","article-title":"An Algorithmic Approach to Triaging Facial Trauma on the Sidelines","volume":"36","author":"Colbenson","year":"2017","journal-title":"Clin. Sports Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1160\/TH08-06-0383","article-title":"Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study","volume":"101","author":"Toulon","year":"2009","journal-title":"Thromb. Haemost."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1001\/jama.2015.12","article-title":"Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs. a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial","volume":"313","author":"Holcomb","year":"2015","journal-title":"JAMA"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1097\/TA.0b013e3181ba7074","article-title":"Clinical Practice Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care","volume":"67","author":"Napolitano","year":"2009","journal-title":"J. Trauma Injury Crit. Care"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/PRS.0b013e31819565da","article-title":"Massive hemorrhage in facial fracture patients: Definition, incidence, and management","volume":"123","author":"Dean","year":"2009","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_78","first-page":"382","article-title":"Management of life threatening hemorrhage from facial fracture","volume":"88","author":"Siritongtaworn","year":"2005","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/BF03050774","article-title":"Role of routine coagulation studies in idiopathic epistaxis","volume":"58","author":"Pande","year":"2006","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"297","DOI":"10.4097\/kja.19169","article-title":"The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management","volume":"72","author":"Dirkmann","year":"2019","journal-title":"Korean J. Anesthesiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40981-019-0224-3","article-title":"Rotational thromboelastometry-guided perioperative management of coagulation in a patient with Heyde\u2019s syndrome undergoing transcatheter aortic valve implantation","volume":"5","author":"Fukuhara","year":"2019","journal-title":"JA Clin. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/1119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:23:33Z","timestamp":1760135013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/1119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,20]]},"references-count":81,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11041119"],"URL":"https:\/\/doi.org\/10.3390\/jcm11041119","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,2,20]]}}}