A review of global coagulation assays — Is there a role in thrombosis risk prediction?

Lim, Hui Yin; O’Malley, Cindy J.; Donnan, Geoffrey A; Nandurkar, Harshal; Ho, Prahlad

doi:10.1016/j.thromres.2019.04.033

Cited by 42 publications

(49 citation statements)

References 73 publications

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“…The mean d-dimer among those on therapeutic versus prophylactic anticoagulation was 2,549 and 705 ng/mL, respectively (p = 0.008); no other clinical or laboratory value differed between these two groups. Table 1 displays each thromboelastography variable by distribution in the study population with reference to normal values (15)(16)(17). Fifty percent of patients had a hypercoagulable thromboelastography profile with CI greater than 3.…”

Section: Resultsmentioning

confidence: 99%

“…The percentage of clot lysed 30 minutes post-MA is termed the Ly 30 (normal range, 0-8%). The clotting index (CI) is calculated as CI = -0.2454 R+ 0.0184 K + 0.1655 MA-0.0241 α-5.0220 with values greater than 3 considered hypercoagulable, -3 to 3 normal range, and less than 3, hypocoagulable (14)(15)(16). Figure 1 is a diagram illustrating thromboelastography variables presented in this study.…”

Section: Thromboelastographymentioning

confidence: 99%

“…Thromboelastography (Haemonetics, Boston, MA) is a point of care viscoelastic test of hemostasis in whole blood which allows for measurement of global clot formation and dissolution in real time (14)(15)(16). Commonly used to guide transfusion of hemostatic products, multiple studies have demonstrated the ability of thromboelastography to identify patients at increased risk for VTE, myocardial infarction, and stroke across various clinical settings (14)(15)(16)(17)(18)(19)(20). To better characterize the coagulation states of critically ill patients with COVID-19, we carried out a retrospective analysis of thromboelastography data obtained on patients with COVID-19 admitted to the ICU.…”

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confidence: 99%

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Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019

Yuriditsky¹,

Horowitz²,

Merchan

et al. 2020

Critical Care Medicine

109

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Objectives: The rate of thromboembolic events among patients with coronavirus disease 2019 is high; however, there is no robust method to identify those at greatest risk. We reviewed thromboelastography studies in critically ill patients with coronavirus disease 2019 to characterize their coagulation states. Design: Retrospective. Setting: Tertiary ICU in New York City. Patients: Sixty-four patients with coronavirus disease 2019 admitted to the ICU with thromboelastography performed. Interventions: None. Measurements and Main Results: Fifty percent of patients had a clotting index in the hypercoagulable range (clotting index > 3) (median 3.05). Reaction time and K values were below the lower limit of normal in 43.8% of the population consistent with a hypercoagulable profile. The median α angle and maximum amplitude (75.8° and 72.8 mm, respectively) were in the hypercoagulable range. The α angle was above reference range in 70.3% of patients indicative of rapid clot formation. Maximum amplitude, a factor of fibrinogen and platelet count and function, and a measure of clot strength was above reference range in 60.1% of patients. Thirtyone percent had thromboembolic events; thromboelastography parameters did not correlate with events in our cohort. Those with d-dimer values greater than 2,000 were more likely to have shorter reaction times compared with those with d-dimer levels less than or equal to 2,000 (4.8 vs 5.6 min; p = 0.001). Conclusions: A large proportion of critically ill patients with coronavirus disease 2019 have hypercoagulable thromboelastography profiles with additional derangements related to fibrinogen and platelet function. As the majority of patients have an elevated thromboelastography maximum amplitude, a follow-up study evaluating platelet aggregation would be instructive.

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Section: Resultsmentioning

confidence: 99%

Section: Thromboelastographymentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019

Yuriditsky¹,

Horowitz²,

Merchan

et al. 2020

Critical Care Medicine

109

View full text Add to dashboard Cite

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“…Based on the thrombin generation profile and its evolution after discontinuation, this decision seems to be rational and congruent with an increasing body of evidence for the role of global coagulation assays in identifying a hypercoagulable state and possibly predicting thrombotic risk. 19 Further prospective studies investigating thrombin generation and risk of venous thromboembolism should be performed to assess whether thrombin generation can identify women taking combined oral contraceptives at high thrombotic risk, who would benefit from an alternative contraception. This could improve the safety of combined oral contraceptive users.…”

Section: Discussionmentioning

confidence: 99%

Thrombin generation in a woman with heterozygous factor V Leiden and combined oral contraceptives: A case report

Zermatten

Calderara

Aliotta

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Combined oral contraceptives and factor V Leiden mutation are multiplicative risk factors for venous thromboembolism. However, it remains unknown whether this multiplicative effect is reflected in thrombin generation assays. We report here the evolution of the thrombin generation profile while taking combined oral contraceptives and after their discontinuation in a woman with heterozygous factor V Leiden mutation. The proband exhibited a distinctly prothrombotic thrombin generation profile including markedly decreased thrombomodulin (TM) sensitivity, compared to the control population. This profile possibly reflected a high thrombotic risk. After discontinuation of combined oral contraceptives, thrombin generation and TM sensitivity improved greatly, leaving only a slightly prothrombotic profile. Therefore, the multiplied thrombotic risk occurring with simultaneous combined oral contraceptives and factor V Leiden mutation is reflected by a thrombin generation assay performed without and with TM. This could be a promising tool to identify women taking combined oral contraceptives at high risk for venous thromboembolism. Further studies are needed to verify this hypothesis.

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“…24 Only a few studies have studied global fibrin generation in (semi-)acute venous thrombosis, these have demonstrated hypercoagulability and hypofibrinolysis compared with healthy controls. 25,26 The Innovance endogenous thrombin potential (ETP) 27 and the OHP 28 assays are GHAs that have been optimized for analysis in routine coagulation laboratories. The OHP is a manual method that has been modified for routine laboratories and the ETP is an automated chromogenic TGA.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

Farm

Antovič

Schmidt

et al. 2020

TH Open

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Introduction For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE. Objective This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE. Methods A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records. Results Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP Tlag were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay. Conclusion Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.

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A review of global coagulation assays — Is there a role in thrombosis risk prediction?

Cited by 42 publications

References 73 publications

Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019

Thromboelastography Profiles of Critically Ill Patients With Coronavirus Disease 2019

Thrombin generation in a woman with heterozygous factor V Leiden and combined oral contraceptives: A case report

Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers

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