Commercial assays for determining
thrombin generation in plasma are being tested in clinical conditions associated with
thrombosis or
bleeding. While pre-analytical conditions remain a source of inter laboratory variation, demanding for further standardization, clinical research proceeds. In patients at risk of
venous thrombosis thrombin generation (TG) analysis may be utilized to detect underlying
thrombophilia and this has been achieved both with addition of
thrombomodulin or activated
protein C, to test the contribution of the
protein C system. In patients with documented
venous thromboembolism, increased TG values are seen in those patients at greatest risk for recurrence, although the data are not consistent yet. In patients with arterial
vascular disease, effects on TG patterns are seen that both reflect
atherosclerosis (and its risk factors) and link to risk of recurrent
atherothrombosis (coronary or
stroke), but the data are limited. In patients with a
bleeding diathesis, like
hemophilia, the main importance of TG assays lies in the application for monitoring replacement
therapy, either with factor concentrate or
rFVIIa. An interesting application is in conjunction with thromboelastography, for monitoring peri-operative transfusion policy. Finally, TG analysis may contribute to monitoring
anticoagulant drug treatment, but these and other applications would greatly benefit from whole blood, point of care applications of TG testing.