The Impact of Tissue Factor Pathway Inhibitor on Coagulation Kinetics Determined by Thrombelastography

Audu, Paul; Nielsen, Vance G.; Armstead, Valerie E.; Powell, Garry; Kim, Jerry; Kim, Larry; Mehta, Munira

doi:10.1213/01.ane.0000237285.40106.1e

Cited by 9 publications

(13 citation statements)

References 11 publications

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“…Retrospective meta-analysis Data derived from 859 thrombelastograms that had both a and MRTG values determined with version 4.2 thrombelastography software were obtained from the databases [1][2][3][4][5][6][7][8][9]. The data were primarily obtained from commercially available lots of human plasma that were normal or deficient in various clotting factors to different extents.…”

Section: Methodsmentioning

confidence: 99%

“…The data were primarily obtained from commercially available lots of human plasma that were normal or deficient in various clotting factors to different extents. Data from wholeblood samples were included from one study [7]. Depending on the investigation, clotting was initiated by contact activation of the sample cup alone, or by various combinations of celite, kaolin or tissue factor.…”

Section: Methodsmentioning

confidence: 99%

“…The quantification of coagulation kinetics utilizing thrombelastography typically involves the determination of the time to clot initiation (reaction time, R), the speed of clot propagation [K time, alpha angle a (degrees), maximum rate of thrombus generation (MRTG) (dynes/cm 2 per s)], and final clot strength [maximum amplitude (mm), maximum elastic modulus (dynes/cm 2 )] [1][2][3][4][5][6][7][8][9]. With regard to clot propagation in particular, the comparison of a values has been widely used in both research and clinical settings despite being a nonparametric measure of velocity.…”

Section: Introductionmentioning

confidence: 99%

“…Such a comparison would yield clinically useful information, giving clinicians a better grasp of how changes in a secondary to therapeutic interventions actually translate to parametric changes in clot growth velocity. One goal of this study was therefore to determine the effect of changes in a on the MRTG using databases from previously published investigations [1][2][3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Thrombelastographic measures of clot propagation: a comparison of alpha with the maximum rate of thrombus generation

Ellis¹,

Nielsen²,

Marques³

et al. 2007

Blood Coagulation &Amp; Fibrinolysis

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The alpha angle alpha (degrees) is a thrombelastographic measure of clot propagation. A parametric measurement of clot propagation [maximum rate of thrombus generation (MRTG), dynes/cm2 per s], however, has recently been utilized. Thus, the relationship of changes in alpha with changes in MRTG were determined. alpha and MRTG values obtained from 859 thrombelastograms was collected from nine studies. Data were analyzed and the relationship between alpha and MRTG defined with commercially available software. Additional comparisons were made retrospectively from whole-blood and plasma data obtained from 33 normal individuals. Data from the nine studies demonstrated that MRTG increased in an exponential fashion compared with increases in alpha (R2 = 0.88, P < 0.001). Whole-blood alpha values were in the range 66.7-74.7 whereas MRTG values were 5.5-10.8, and plasma alpha values were 65.1-77.9 with corresponding MRTG values of 3.5-12.0. Assessment of clot propagation utilizing MRTG provides a more parametric evaluation than the determination of alpha. While normal alpha values may vary by only 12-20%, MRTG values vary by approximately 200-300%. The MRTG should be progressively utilized to a greater extent in both laboratory and clinical settings to parametrically quantify clot growth kinetics with thrombelastography.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thrombelastographic measures of clot propagation: a comparison of alpha with the maximum rate of thrombus generation

Ellis¹,

Nielsen²,

Marques³

et al. 2007

Blood Coagulation &Amp; Fibrinolysis

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“…Thus, our results do not account for the ability of LMWHs and UH to release TFPI from endothelial cells [25,31,32] . TFPI has been shown to modify the thrombelastographic profile [33] . Moreover, our experiments were performed in cord WB and not in true newborn blood because of ethical reasons.…”

Section: Discussionmentioning

confidence: 99%

Effects of Nadroparin, Enoxaparin, and Unfractionated Heparin on Endogenous Formation of Factor Xa and IIa and on Thrombelastometry Profiles in Cord versus Adult Blood

Cvirn¹,

Hörl²,

Tafeit³

et al. 2010

Neonatology

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Background: To date, only few pharmacokinetic studies on low-molecular-weight heparins (LMWHs) in neonates exist not allowing to formally assess pharmacodynamics of LMWHs in neonates. Objective: To evaluate the anticoagulant effects of the two LMWHs nadroparin and enoxaparin on endogenous formation of FXa or FIIa in cord versus adult platelet-poor plasma (PPP) and on thrombelastometry profiles in cord versus adult whole blood (WB). Unfractionated heparin (UH) was the reference antithrombotic drug. Methods: The effects of nadroparin, enoxaparin, or UH on endogenous formation of FXa or FIIa was investigated in tissue factor-activated PPP using a subsampling technique and chromogenic substrates. The anticoagulant efficacy of these drugs was also investigated in WB triggered by the physiological relevant activator collagen/endogenous thrombin using thrombelastometry. Results: The major findings are (i) nadroparin is as efficient as enoxaparin concerning inhibition of the endogenous formation of FXa and FIIa, (ii) cord PPP and WB are significantly more susceptible to the addition of LMWHs or UH than adult PPP or WB, and (iii) compared by equivalent anti-FXa activity, the anticoagulant action of UH is markedly higher than that of the LMWHs in PPP and WB of neonatal or adult origin. Conclusions: Administration of LMWHs in neonates has to be performed carefully to avoid bleeding side effects due to their high anticoagulant efficacy in cord PPP and WB.

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Beyond uterine atony: characterizing postpartum hemorrhage coagulopathy

Coleman

Fabbri

Anderson

et al. 2023

American Journal of Obstetrics & Gynecology MFM

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The Impact of Tissue Factor Pathway Inhibitor on Coagulation Kinetics Determined by Thrombelastography

Abstract: In settings involving heparin administration (e.g., cardiopulmonary bypass), TFPI-mediated inhibition of coagulation should be considered during TEG-based hemostatic monitoring.

Cited by 9 publications

References 11 publications

Thrombelastographic measures of clot propagation: a comparison of alpha with the maximum rate of thrombus generation

Thrombelastographic measures of clot propagation: a comparison of alpha with the maximum rate of thrombus generation

Effects of Nadroparin, Enoxaparin, and Unfractionated Heparin on Endogenous Formation of Factor Xa and IIa and on Thrombelastometry Profiles in Cord versus Adult Blood

Beyond uterine atony: characterizing postpartum hemorrhage coagulopathy

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