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Thrombin generation in clinical conditions.

Abstract
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.
AuthorsHugo Ten Cate
JournalThrombosis research (Thromb Res) Vol. 129 Issue 3 Pg. 367-70 (Mar 2012) ISSN: 1879-2472 [Electronic] United States
PMID22079443 (Publication Type: Journal Article, Review)
CopyrightCopyright © 2011. Published by Elsevier Ltd.
Chemical References
  • Biomarkers
  • Coagulants
  • Fibrinolytic Agents
  • Thrombin
Topics
  • Animals
  • Biomarkers (blood)
  • Blood Coagulation (drug effects)
  • Blood Coagulation Tests (standards)
  • Cardiovascular Diseases (blood, diagnosis, drug therapy)
  • Coagulants (therapeutic use)
  • Drug Monitoring (methods, standards)
  • Fibrinolytic Agents (therapeutic use)
  • Hemophilia A (blood, diagnosis, drug therapy)
  • Humans
  • Predictive Value of Tests
  • Thrombin (metabolism)
  • Thrombosis (blood, diagnosis, drug therapy)

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