Visual ClotOnline-Simulator

See coagulation. Understand the curve.

Select deficiencies or effects

Visual ClotBlender render · Main view

Loading rendering …

What you see · Complete clot

Platelets, fibrin and factors present. No bleeding.

Details · visual symbols

FibrinMesh present · dashed mesh missing

PlateletsDisc present · dashed outline missing

Coagulation factorsGold spheres present · outlines missing

HyperfibrinolysisHarvesters break down fibrin

Heparin effectPurple clusters labelled HEP

BleedingFalling blood drops

Original Visual Clot symbols. Red discs in the background are red blood cells. Missing components flash in the animation.

Visual interpretation uses the current measurement and mapping cutoffs.

Result

Comparison assay

EXTEMChannel 1

CT: 67 s
CFT: 90 s
α: 70 °
A10: 48 mm
MCF: 60 mm
ML: 0 %

INTEMChannel 2

CT: 180 s
CFT: 90 s
α: 70 °
A10: 48 mm
MCF: 60 mm
ML: 0 %

FIBTEMChannel 3

CT: 65 s
CFT: – s
α: – °
A10: 12 mm
MCF: 15 mm
ML: 0 %

APTEMChannel 4

CT: 70 s
CFT: 90 s
α: 70 °
A10: 48 mm
MCF: 60 mm
ML: 0 %

What the traces show · ROTEM

EXTEM CT: within reference range (67 s).
INTEM CT: within reference range (180 s).
EXTEM firmness (MCF): within reference range (60 mm).
INTEM firmness (MCF): within reference range (60 mm).
FIBTEM firmness (MCF): within reference range (15 mm).
No increased EXTEM lysis at the current cutoff.

Details · how to interpret this

Read left to right: time to clot formation, increasing width (firmness), then any late narrowing (lysis). The upper and lower outlines mirror the same signal.

Onset — EXTEM CT 67 s; INTEM CT 180 s. A longer flat beginning means delayed clot initiation. CT alone does not identify its cause.
Firmness — EXTEM MCF 60 mm; INTEM MCF 60 mm. Wider curves mean a firmer clot; interpret total firmness together with FIBTEM.
Fibrin contribution — FIBTEM MCF 15 mm is not below the current 9 mm deficiency cutoff. Low EXTEM/INTEM with preserved FIBTEM suggests a reduced platelet contribution.
Lysis comparison — EXTEM ML 0%; APTEM ML 0%. No EXTEM/APTEM lysis pattern at the current cutoffs.

Simple findings use published reference ranges; detailed interpretations use current simulator cutoffs. References are available below.

Curves reconstructed from source shapes · CT/CFT in seconds, clot firmness in mm.

Visual Clot from ROTEM values · default thresholdsVisual Clot develops with the measurement. Missing components during growth are provisional.

Published reference ranges · ROTEM

Reference intervals for the selected assay profile. These describe completed measurements, not the initial flat trace, and are distinct from treatment thresholds and Visual Clot mapping rules.

Assay / cartridge	Published interval	Scope	Source
EXTEM	CT 38–79 s; CFT 34–159 s; MCF 50–72 mm	Adult reference intervals	Crochemore et al., 2018
INTEM	CT 100–240 s; CFT 30–110 s; MCF 50–72 mm	Adult reference intervals	Crochemore et al., 2018
FIBTEM	MCF 9–25 mm	Not the conditional platelet cutoffs	Visual Clot Table S1

Sources checked 2 October 2026. Adult profiles; not paediatric or pregnancy-specific. Local laboratory intervals may differ. Modelled normal values are not an individual published patient record.

Advanced settings · ROTEM Visual Clot thresholds

ROTEM: Mapping thresholds

Changes apply to this session and device. They change Visual Clot, not the simulated measurement values. The ROTEM source cases retain their original mapping.

Defaults: Table S1, Castellucci et al. (2022). All comparisons use strict < or > operators.

Default rules and their evidence · ROTEM

Visual Clot rule	Default	Evidence / limitation
Fibrin deficiency: FIBTEM MCF <	9 mm	Published Visual Clot algorithm · Table S1
High FIBTEM MCF >	25 mm	Published Visual Clot algorithm · Table S1
Platelet deficiency with low FIBTEM: EXTEM/INTEM MCF <	30 mm	Published Visual Clot algorithm · Table S1
Platelet deficiency with intermediate FIBTEM: EXTEM/INTEM MCF <	40 mm	Published Visual Clot algorithm · Table S1
Platelet deficiency with high FIBTEM: EXTEM/INTEM MCF <	50 mm	Published Visual Clot algorithm · Table S1
Platelet deficiency with elevated lysis: APTEM MCF <	30 mm	Published Visual Clot algorithm · Table S1
Lysis: ML > and APTEM ML <	15 %	Published Visual Clot algorithm · Table S1
Factors: EXTEM CT > (without another disorder)	79 s	Published Visual Clot algorithm · Table S1
Factors: INTEM CT > (without another disorder)	240 s	Published Visual Clot algorithm · Table S1
Factors regardless of other disorders: EXTEM CT >	100 s	Published Visual Clot algorithm · Table S1
Factors regardless of other disorders: INTEM CT >	260 s	Published Visual Clot algorithm · Table S1
Heparin: INTEM CT >	240 s	Published Visual Clot algorithm · Table S1
and HEPTEM CT <	240 s	Published Visual Clot algorithm · Table S1
Hypercoagulability: EXTEM/INTEM MCF >	72 mm	Published Visual Clot algorithm · Table S1

The controls below show the currently applied or edited values. Default values above remain the documented baseline.

Fibrin deficiency: FIBTEM MCF <

High FIBTEM MCF >

Platelet deficiency with low FIBTEM: EXTEM/INTEM MCF <

Platelet deficiency with intermediate FIBTEM: EXTEM/INTEM MCF <

Platelet deficiency with high FIBTEM: EXTEM/INTEM MCF <

Platelet deficiency with elevated lysis: APTEM MCF <

Lysis: ML > and APTEM ML <

Factors: EXTEM CT > (without another disorder)

Factors: INTEM CT > (without another disorder)

Factors regardless of other disorders: EXTEM CT >

Factors regardless of other disorders: INTEM CT >

Heparin: INTEM CT >

and HEPTEM CT <

Hypercoagulability: EXTEM/INTEM MCF >

Published Visual Clot rule; high firmness is shown after the observed curve crosses this cutoff.

Source material, references and model limitations · ROTEM

Hypercoagulability: Rössler et al., Anaesthesia 2020 includes hypercoagulable scenarios. The ROTEM rule (EXTEM or INTEM MCF > 72 mm) is documented in the published Visual Clot algorithm. This preset uses illustrative high-firmness curves, not the unavailable original supplemental trace. For TEG, CRT MA > 70 mm, and for Quantra, QStat CS > 35.4 hPa, are teaching mappings from upper reference limits, not validated hypercoagulability diagnostic criteria. Reduced stretching is a new teaching visual. Hypercoagulability alone does not produce a bleeding effect once clot development is complete.

Scenario controls generate fixed teaching values specific to each device. These are not patient measurements or conversions between ROTEM and TEG. Thresholds then determine the Visual Clot display. Switching devices retains the scenario and the respective thresholds, and returns playback to the completed result.

Quantra: separate simulated QPlus and QStat cartridges. Factors and heparin use QPlus CT/CTH/CTR; fibrin and platelets use QStat FCS/PCS; lysis uses QStat CSL. Parameter availability and the 60-minute stiffness curves are illustrative, not proprietary SEER processing or patient recordings. Final stiffness is released at 12.5 minutes and CSL at 30 minutes in this teaching model. Reference intervals are not validated treatment triggers or an established Quantra-to-Visual-Clot algorithm.

ROTEM: Castellucci et al., Diagnostics 2022, Table S1. Open all ten source cases with original images. APTEM and HEPTEM are both calculated and included in the mapping. The fourth visible assay can be switched. The strong CT rule may also indicate factor deficiency when heparin is present.

TEG 6s: Display based on VC@Hemosonics.pptx, CM cartridge CK/CRT/CKH/CFF. Haemonetics CM cartridge reference and TEG 6s user manual. CK-R, or CKH-R when heparin is detected, maps to factors; CFF-MA to fibrin; CRT-MA to platelets; and CRT-LY30 to lysis. A CK/CKH ratio of 1.5 and a CRT-MA cutoff of 40 mm when CFF is low are unvalidated teaching assumptions for combined scenarios.

During playback, growing clot amplitudes are compared with the mapping cutoffs. Components start absent; CT/R and heparin require observed timing evidence. ROTEM lysis uses observed amplitude loss and APTEM; TEG LY30 is used only at MA + 30 minutes. Early absence means pending clot development, not a confirmed deficiency. This temporal extension is an illustrative teaching rule. Curve shapes are traced from the supplied PowerPoint images and adapted to the teaching values. TEG uses the CK/CRT/CKH/CFF colour envelopes; ROTEM uses the original filled silhouettes. These reconstructions retain measurement landmarks but are not original patient traces. All curves run to 60 minutes; after the modelled lysis interval the residual amplitude is held. LY30 remains pending if MA + 30 minutes falls after the measurement window. The TEG lysis envelope is adapted to MA + 30 minutes and does not reproduce the device’s area-based LY30 calculation. Angle is a reference value; TEG-ACT, A10 and FLEV are not calculated. CKH and CFF do not report LY30. Curves and binary mappings are not clinically validated.

Original TEG images from the presentation

Original TEG mapping from the presentation

TEG teaching case 1 from the presentation

TEG teaching case 2 from the presentation

TEG teaching case 3 from the presentation

TEG teaching case 4 from the presentation