Thrombin generation assays and their clinical application

Abstract

A trombin a véralvadási kaszkád egyik kulcsenzime, amely mind pro-, mind antikoaguláns funkcióval rendelkezik. Központi szerepe folytán a trombin képződése a véralvadási folyamat egyik legfontosabb lépése, amely az úgynevezett trombingenerációs vizsgálattal jellemezhető. A trombingeneráció globális véralvadási teszt, amely átfogó képet ad a haemostasis állapotáról. Karakterisztikáját egyaránt befolyásolják a pro-és az antikoaguláns folyamatok, ezáltal alkalmas a fokozott trombóziskészség és a vérzékenység kimutatására is. Klinikai vizsgálatok igazolják a trombingeneráció fokozódását vénás és artériás trombózishajlam esetében. Segíthet az antikoaguláns terápia monitorozásában, faktorinhibitorokkal történő antikoaguláns kezelés esetében is. A trombingenerációs vizsgálatok eredményei hemofília esetén jól tükrözik a vérzés súlyosságát, és monitorozható a faktorkészítményekkel történő terápia. Információt adhat azokban az esetekben is, amikor a hemofíliás betegnél inhibitorok jelennek meg, és emiatt speciális kezelésre van szükség. A klinikai gyakorlatban történő alkalmazáshoz elengedhetetlen a módszer standardizálása és a klinikai dön-téshozatalhoz szükséges küszöbértékek meghatározása. Orv. Hetil., 2014, 155(22), 851-857. Kulcsszavak: véralvadási vizsgálatok, trombózis, vérzékenység, trombin Thrombin generation assays and their clinical applicationThrombin is a key enzyme of the coagulation system, having both pro-and anticoagulant functions. Thus, the generation of thrombin is one of the most important steps in coagulation. Global haemostasis assay, the so-called thrombin generation test is appropriate for its assessment. Since thrombin generation is sensible for both pro-and anticoagulant processes it can be applied for the general characterisation of the risk of thrombosis and bleeding, too. Clinical studies confi rmed augmented thrombin generation in patients with high risk of venous or arterial thrombosis. Anticoagulant therapy (also novel oral anticoagulant treatment) can be monitored by thrombin generation. In case of haemophilia thrombin generation assays refl ect bleeding severity. It is applicable for monitoring of both conventional haemophilia treatment and inhibitor-bypassing therapy, which is needed when inhibitors develop in patients. Standardization of thrombin generation methods and determination of cut off values are required before its application in clinical practice.

Preventive Effect of Aspirin Eugenol Ester on Thrombosis in κ-Carrageenan-Induced Rat Tail Thrombosis Model

“…Thrombin is at the center of the process of blood clotting [ 38 – 39 ]. In order to control thrombin and regulate blood clotting carefully, thrombin is built as an inactive precursor, prothrombin [ 40 ].…”

Effect of the injectable contraceptive depot‐medroxyprogesterone acetate on coagulation parameters in new users

“…In addition, the beneficial results obtained from this assessment of thrombin generation were based on a new TGT technique that consists of the dynamic evaluation of different parameters that add to the quality of the test and its results . Thrombin is one of the most critical components of the coagulation process and has been growing in importance in recent decades as an alternative form of evaluating coagulation . Both D‐dimer and TGT have been shown to be effective for the evaluation of blood hypercoagulability …”

“…22 Thrombin is one of the most critical components of the coagulation process and has been growing in importance in recent decades as an alternative form of evaluating coagulation. 23 Both D-dimer and TGT have been shown to be effective for the evaluation of blood hypercoagulability. 17,19,22 The TGT is a new approach and is a promising method for the clinical management of bleeding and thrombosis disease.…”

Global clotting assays - monitoring the effect of by-passing agents in haemophilia patients with inhibitors

“…The following parameters were analyzed by means of a dedicated software: lag time (s), endogenous thrombin potential (nM*min) (ETP), peak height (nM), time to peak (s) (ttpeak), start tail (min), and velocity index (nM/min). (2,4,14) Clinical evaluation of BPAs efficacy was performed by a 4-point scale (Rating Scale for …”

“…Its main therapeutically-induced complication, the occurrence of neutralizing inhibitors, is also well controlled with the use of by-passing agents (BPAs) (1)(2)(3)(4).…”