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Talon L, Sinegre T, Lecompte T, Pereira B, Massoulié S, Abergel A, Lebreton A. Hypercoagulability (thrombin generation) in patients with cirrhosis is detected with ST-Genesia. J Thromb Haemost 2020; 18:2177-2190. [PMID: 32558351 DOI: 10.1111/jth.14963] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/06/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thrombin generation assays (TGAs) performed with calibrated automated thrombography (CAT) in the presence of thrombomodulin (TM) indicate plasma hypercoagulability in cirrhosis. OBJECTIVE To evaluate, in the presence of TM, the new ST-Genesia automated device developed for improving TGA vs the previously used CAT method, with plasma samples of patients with cirrhosis. PATIENTS/METHODS Platelet-poor plasma samples were prepared from citrated blood samples of 52 healthy controls and 85 patients with cirrhosis (severity evaluated using the Child-Pugh score [CP]). TGAs were performed using CAT with PPP-Reagent and ST-Genesia with the STG-ThromboScreen reagent, in the presence of TM. Endogenous thrombin potential (ETP) was chosen as the main parameter. RESULTS Whatever the method, ETP values were higher in patients than in healthy controls. All patients identified as hypercoagulable with ST-Genesia and STG-ThromboScreen were found hypercoagulable with CAT and PPP-Reagent. Conversely, eight and ten patients in the CP-A and CP-B classes respectively were identified as hypercoagulable only with CAT. The use of ST-Genesia with the STG-ThromboScreen reagent with TM led to a bias, with higher ETP values for healthy controls and lower for patients compared with CAT. Crossover analysis (CAT with the STG-ThromboScreen reagent) evidenced a substantial effect of the STG-ThromboScreen reagent; the analyzer (including calibration and data analysis) plays a lesser role. CONCLUSION ST-Genesia evidences hypercoagulability in patients with cirrhosis when TG is studied in the presence of TM, but the results are not interchangeable with those obtained with CAT.
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Affiliation(s)
- Laurie Talon
- Service d'hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Sinegre
- Service d'hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Lecompte
- Hôpitaux Universitaires de Genève, Unité d'hémostase, Département de médecine, faculté de Médecine - GpG, Université de Genève, Geneva, Switzerland
| | - Bruno Pereira
- Unité de Biostatistiques (Direction de la recherche clinique et de l'innovation), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvie Massoulié
- Service d'Hépato-Gastro-Entérologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Armand Abergel
- Service d'Hépato-Gastro-Entérologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Lebreton
- Service d'hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France
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de Laat-Kremers RMW, Ninivaggi M, Devreese KMJ, de Laat B. Towards standardization of thrombin generation assays: Inventory of thrombin generation methods based on results of an International Society of Thrombosis and Haemostasis Scientific Standardization Committee survey. J Thromb Haemost 2020; 18:1893-1899. [PMID: 32319140 DOI: 10.1111/jth.14863] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thrombin generation (TG) is a better determinant of the overall function of the hemostatic system than the routinely used clotting time-based assays. Nowadays, TG is widely used in hemostasis research teams, for both clinical and basic research. However, there is significant variability between laboratories regarding preanalytics, reagents, TG protocol, analysis interpretation, and normalization. OBJECTIVES To document the extent of variation in the methodology of TG, we aim to collect all the methods that are being used to measure TG in a survey. METHODS We organized a questionnaire through the Standardization committee for Lupus Anticoagulant/Antiphospholipid Antibodies of the International Society of Thrombosis and Haemostasis Scientific Standardization committee. The questionnaire consisted of 51 questions regarding the different aspects of TG: type of users, methods, sample type, analysis, and interpretation of results, normalization, and quality control. RESULTS Of the 240 surveys that were started, 108 were completed (45%). However, not all questions were in scope for all laboratories. One-half of the laboratories were research laboratories and half diagnostic laboratories. The most used TG assay was the calibrated automated thrombinography-based assay (56%). There was a divergence regarding several aspects of the TG assay: type of needle for blood collection, blood tubes, centrifugation, sample storage and thawing, reagents, sample dilution, calibration, reference ranges, data normalization, and so on. CONCLUSIONS There is an important variation in the methods used for measuring TG. A standardized protocol and data normalization should lead to a better reproducibility and for comparing data from different laboratories.
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Affiliation(s)
| | | | - Katrien M J Devreese
- Department of Laboratory Medicine, Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Bas de Laat
- Synapse Research Institute, Maastricht, The Netherlands
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Brouns SLN, van Geffen JP, Campello E, Swieringa F, Spiezia L, van Oerle R, Provenzale I, Verdoold R, Farndale RW, Clemetson KJ, Spronk HMH, van der Meijden PEJ, Cavill R, Kuijpers MJE, Castoldi E, Simioni P, Heemskerk JWM. Platelet-primed interactions of coagulation and anticoagulation pathways in flow-dependent thrombus formation. Sci Rep 2020; 10:11910. [PMID: 32680988 PMCID: PMC7368055 DOI: 10.1038/s41598-020-68438-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
In haemostasis and thrombosis, platelet, coagulation and anticoagulation pathways act together to produce fibrin-containing thrombi. We developed a microspot-based technique, in which we assessed platelet adhesion, platelet activation, thrombus structure and fibrin clot formation in real time using flowing whole blood. Microspots were made from distinct platelet-adhesive surfaces in the absence or presence of tissue factor, thrombomodulin or activated protein C. Kinetics of platelet activation, thrombus structure and fibrin formation were assessed by fluorescence microscopy. This work revealed: (1) a priming role of platelet adhesion in thrombus contraction and subsequent fibrin formation; (2) a surface-independent role of tissue factor, independent of the shear rate; (3) a mechanism of tissue factor-enhanced activation of the intrinsic coagulation pathway; (4) a local, suppressive role of the anticoagulant thrombomodulin/protein C pathway under flow. Multiparameter analysis using blood samples from patients with (anti)coagulation disorders indicated characteristic defects in thrombus formation, in cases of factor V, XI or XII deficiency; and in contrast, thrombogenic effects in patients with factor V-Leiden. Taken together, this integrative phenotyping approach of platelet–fibrin thrombus formation has revealed interaction mechanisms of platelet-primed key haemostatic pathways with alterations in patients with (anti)coagulation defects. It can help as an important functional add-on whole-blood phenotyping.
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Affiliation(s)
- Sanne L N Brouns
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Johanna P van Geffen
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Elena Campello
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Frauke Swieringa
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Protein Dynamics, Leibniz Institute for Analytical Sciences, ISAS, Dortmund, Germany
| | - Luca Spiezia
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - René van Oerle
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Isabella Provenzale
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Remco Verdoold
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | | | - Kenneth J Clemetson
- Department of Haematology, Inselspital, University of Berne, Berne, Switzerland
| | - Henri M H Spronk
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Paola E J van der Meijden
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Rachel Cavill
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, The Netherlands
| | - Marijke J E Kuijpers
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Elisabetta Castoldi
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Paolo Simioni
- Department of Medicine, University of Padua Medical School, Padua, Italy.
| | - Johan W M Heemskerk
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Thrombin generation in children with sickle cell Anemia is Higher in the presence of platelets ⋆ and ⋆. Transfus Apher Sci 2020; 59:102852. [PMID: 32576489 DOI: 10.1016/j.transci.2020.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
Cellular and plasma interactions underlie hypercoagulability in sickle cell anemia (SCA). In healthy adults, thrombin generation (TG), a biomarker of hypercoagulability, is similar in plasma with and without platelets. Studies investigating TG in SCA using platelet-poor plasma (PPP) show conflicting results. There are no studies in SCA simultaneously comparing TG using platelet rich plasma (PRP) and PPP. This prospective study compares TG in children with SCA, at steady state, in PPP versus PRP and investigates the association of predefined clinical variables with the difference between PRP and PPP. Our secondary aim was to investigate derangements in the protein C and S pathway measuring TG with and without thrombomodulin (TM). In forty-three paired samples from SCA patients, aged 2-15 years, TG in the presence of platelets was 5.9 % higher [1239 nmol/(min*L) (SD: 224.1) vs. 1151 nmol/(min*L) (SD 223.3); p = 0.026]. The difference was highest in the 6-10 year age group (9.5 %; SD 14.1) followed by the 2-5 year age group (5.4 %; SD 21.4). In a multiple linear regression model, age, gender, current use of hydroxyurea, degree of hemolysis and severity of pain crises were not predictive of the difference between PRP and PPP. In PPP, TG reduction after TM addition was 7.4 % (SD 16.8), signifying activated protein C resistance. In conclusion, TG in children with SCA aged 2-10 years is higher in the presence of platelets. TG using PRP along with TM addition may be a useful biomarker of hypercoagulability in this population.
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Pfrepper C, Metze M, Siegemund A, Klöter T, Siegemund T, Petros S. Direct oral anticoagulant plasma levels and thrombin generation on ST Genesia system. Res Pract Thromb Haemost 2020; 4:619-627. [PMID: 32548561 PMCID: PMC7292659 DOI: 10.1002/rth2.12340] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Monitoring of anticoagulant activity of direct oral anticoagulants (DOACs) can be necessary in special situations. DOAC plasma levels have a high inter- and intraindividual variation and do not necessarily reflect the coagulation status of the patient. Thrombin generation (TG) is a global hemostatic assay with the capacity to overcome this limitation. The aim of this study was to show correlations between DOAC plasma levels and TG parameters using the fully automated ST Genesia system. METHODS A total of 380 blood samples (120 with apixaban, 79 with dabigatran, 79 with edoxaban, and 102 with rivaroxaban) from patients at different time points after DOAC intake were included in the analysis. DOAC plasma levels were analyzed using calibrated anti-Xa or anti-IIa tests. Thrombin generation was measured using the ST Genesia system and STG-DrugScreen reagent. RESULTS There was a significant correlation between the drug levels of all DOACs and the TG parameters' lag time and time to peak. Peak thrombin and velocity index show a negative correlation following an exponential regression curve with all anti-Xa DOACs but not with dabigatran. Apart from a weak correlation with rivaroxaban, there was no correlation between drug levels of all other DOACs and endogenous thrombin potential. CONCLUSION TG parameters measured with ST Genesia correlate with the drug levels of anti-Xa DOACs. Peak thrombin and velocity index are of special interest for the determination of residual anticoagulant effect at low drug levels. For dabigatran-treated patients, only lag time shows a correlation with the dabigatran plasma levels.
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Affiliation(s)
- Christian Pfrepper
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
| | - Michael Metze
- Department of CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Annelie Siegemund
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
- Medical ICUUniversity Hospital LeipzigLeipzigGermany
| | - Tristan Klöter
- Department of CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Thomas Siegemund
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
- Medical ICUUniversity Hospital LeipzigLeipzigGermany
| | - Sirak Petros
- Division of HemostaseologyMedical Department IUniversity Hospital LeipzigLeipzigGermany
- Medical ICUUniversity Hospital LeipzigLeipzigGermany
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Veen CSB, Huisman EJ, Cnossen MH, Kom‐Gortat R, Rijken DC, Leebeek FWG, Maat MPM, Kruip MJHA. Evaluation of thromboelastometry, thrombin generation and plasma clot lysis time in patients with bleeding of unknown cause: A prospective cohort study. Haemophilia 2020; 26:e106-e115. [DOI: 10.1111/hae.13991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/01/2020] [Accepted: 03/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Caroline S. B. Veen
- Department of Haematology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - Elise J. Huisman
- Department of Paediatric Haematology Erasmus University Medical Center - Sophia Children's Hospital Rotterdam The Netherlands
| | - Marjon H. Cnossen
- Department of Paediatric Haematology Erasmus University Medical Center - Sophia Children's Hospital Rotterdam The Netherlands
| | - Regina Kom‐Gortat
- Department of Haematology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - Dingeman C. Rijken
- Department of Haematology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - Frank W. G. Leebeek
- Department of Haematology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - Moniek P. M. Maat
- Department of Haematology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
| | - Marieke J. H. A. Kruip
- Department of Haematology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands
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57
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Morimont L, Bouvy C, Delvigne AS, Dogné JM, Douxfils J. Proof of concept of a new scale for the harmonization and the standardization of the ETP-based APC resistance. J Thromb Haemost 2020; 18:895-904. [PMID: 31984653 DOI: 10.1111/jth.14745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The evaluation of the activated protein C resistance (APCr) based on the endogenous thrombin potential (ETP) is recommended during the development of steroid contraceptives. Results are usually expressed as "normalized APC sensitivity ratio" (nAPCsr) using a reference plasma that should achieve an ETP ratio of 0.1 in presence of exogenous APC. Because of the interassay variability, achieving exactly an ETP ratio of 0.1 in each run is almost impossible, which significantly affects the theoretical 0-10 scale of nAPCsr. OBJECTIVES To compare the nAPCsr to the nAPCsr10 , a newly proposed method to express the degree of APC resistance. METHODS Individual plasma samples (n = 854) were analyzed to compare nAPCsr and nAPCsr10 . These values were obtained using the validated ETP-based APCr assay. RESULTS The Spearman correlation between nAPCsr and nAPCsr10 had a coefficient of 0.99. Linear regression showed the following equation y = 0.9315*x + 0.03942 (r2 = .97). When differences (nAPCsr10 - nAPCsr) were plotted against nAPCsr10 , the mean difference equaled 0.16% or 4.95%. The correction obtained with the use of the nAPCsr10 showed that the results of the nAPCsr were statistically different (P < .0001). CONCLUSIONS This new scale provides a harmonization and normalization of the nAPCsr. Results show a better reproducibility with the nAPCsr10 . It avoids the additional variability and the unharmonized scale introduced by the use of a reference plasma. This adapted method for the calculation of the APC resistance could provide the regulatory and scientific bodies with more reproducible and harmonized evaluations.
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Affiliation(s)
- Laure Morimont
- Qualiblood sa, Namur, Belgium
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences, University of Namur, Namur, Belgium
| | | | | | - Jean-Michel Dogné
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences, University of Namur, Namur, Belgium
| | - Jonathan Douxfils
- Qualiblood sa, Namur, Belgium
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences, University of Namur, Namur, Belgium
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Poitout-Belissent F, Culang D, Poulin D, Samadfan R, Cotton S, Bédard C. Monitoring Compound-Related Effects on Coagulability in Rats and Cynomolgus and Rhesus Monkeys by Thrombin Generation Kinetic Measurement. Int J Toxicol 2020; 39:207-217. [PMID: 32153221 DOI: 10.1177/1091581820907324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thrombin generation assay (TGA) is a sensitive method for the assessment of the global clotting potential of plasma. This kinetic assay can detect both hypocoagulable and hypercoagulable conditions: delayed or reduced thrombin generation leading to a prolonged clotting time, or induced thrombin activity, shifting the coagulation cascade toward thrombosis. The purpose of this study is to qualify the TGA in nonhuman primates (NHP) and rats for its use during nonclinical in vivo and in vitro studies. Blood was drawn from nonanesthetized animals, and platelet-poor plasma was obtained after double centrifugation; coefficients of variation were <10% for all derived parameters of thrombin generation assessed with 5 pM of tissue factor. Thrombin generation was evaluated in vitro in rat and NHP plasmas with ascending doses of unfractionated heparin (UFH), recombinant tissue factor, and anticoagulant compounds. Thrombin generation was decreased with UFH and anticoagulant compounds, but was increased in the presence of tissue factor, in a dose-dependent manner. In a rat model of inflammation, animals were administered a low dose of lipopolysaccharides. Thrombin generation measurements were decreased 3 hours post-LPS administration with a nadir at 24 hours, while thrombin-antithrombin complexes reached a peak at 8 hours, supporting an earlier production of thrombin. In conclusion, these data demonstrated that TGA can be performed in vitro for screening of compounds expected to have effects on coagulation cascade, and thrombin generation can be measured at interim time points during nonclinical in vivo studies in rats and NHP.
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Affiliation(s)
| | - D Culang
- Pathology and Microbiology Department, St.-Hyacinthe Veterinary School, University of Montreal, Canada
| | - D Poulin
- Charles River Laboratories, ULC, Senneville, Canada
| | - R Samadfan
- Charles River Laboratories, ULC, Senneville, Canada
| | - S Cotton
- Charles River Laboratories, ULC, Senneville, Canada
| | - C Bédard
- Pathology and Microbiology Department, St.-Hyacinthe Veterinary School, University of Montreal, Canada
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Kristensen SR, Nybo J, Pedersen S. The effect of pH on thrombin generation-An unrecognized potential source of variation. Res Pract Thromb Haemost 2020; 4:224-229. [PMID: 32110752 PMCID: PMC7040540 DOI: 10.1002/rth2.12289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND When CO2 escapes from plasma, the pH of the plasma increases. In samples left open or kept in long-term storage, the pH may increase considerably. Assays in which the ratio of plasma sample relative to the total volume including reagents is high may be sensitive to the pH of the plasma sample. OBJECTIVE The aim was to investigate the effect of the pH of plasma samples used in the calibrated automated thrombin generation (CAT) assay in which the ratio (plasma sample) / (total volume) is high. METHODS Plasma pH was increased by allowing CO2 to escape in open beakers before the CAT analysis. The effect of pH was also investigated by mixing plasma with buffers with different pH levels. RESULTS At a pH close to 8.0, endogenous thrombin potential (ETP) and peak decreased considerably, whereas lagtime and time-to-peak were modestly increased. Mixtures of plasma and buffer with pH levels between 7 and 8 showed that ETP and peak decreased at alkaline pH; lagtime and time-to-peak were higher at acidic pH levels but were shortened, partly in contrast to first results, at alkaline pH levels. The addition of 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid buffer to plasma with a high pH attenuated the effects; however, the effect was most significant if added before the CO2 escaped. CONCLUSION Modifications of plasma pH can significantly alter thrombin generation. In alkaline samples, for example, after lengthy storage in a freezer where pH can increase considerably, thrombin generation is lowered. To minimize this effect, plasma should be stored in tubes filled to the maximum volume.
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Affiliation(s)
- Søren Risom Kristensen
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Jette Nybo
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
| | - Shona Pedersen
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Visser M, van Oerle R, ten Cate H, Laux V, Mackman N, Heitmeier S, Spronk HM. Plasma Kallikrein Contributes to Coagulation in the Absence of Factor XI by Activating Factor IX. Arterioscler Thromb Vasc Biol 2020; 40:103-111. [DOI: 10.1161/atvbaha.119.313503] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
FXIa (factor XIa) induces clot formation, and human congenital FXI deficiency protects against venous thromboembolism and stroke. In contrast, the role of FXI in hemostasis is rather small, especially compared with FIX deficiency. Little is known about the cause of the difference in phenotypes associated with FIX deficiency and FXI deficiency. We speculated that activation of FIX via the intrinsic coagulation is not solely dependent on FXI(a; activated FXI) and aimed at identifying an FXI-independent FIX activation pathway.
Approach and Results:
We observed that ellagic acid and long-chain polyphosphates activated the coagulation system in FXI-deficient plasma, as could be demonstrated by measurement of thrombin generation, FIXa-AT (antithrombin), and FXa-AT complex levels, suggesting an FXI bypass route of FIX activation. Addition of a specific PKa (plasma kallikrein) inhibitor to FXI-deficient plasma decreased thrombin generation, prolonged activated partial thromboplastin time, and diminished FIXa-AT and FXa-AT complex formation, indicating that PKa plays a role in the FXI bypass route of FIX activation. In addition, FIXa-AT complex formation was significantly increased in
F11
−/−
mice treated with ellagic acid or long-chain polyphosphates compared with controls and this increase was significantly reduced by inhibition of PKa.
Conclusions:
We demonstrated that activation of FXII leads to thrombin generation via FIX activation by PKa in the absence of FXI. These findings may, in part, explain the different phenotypes associated with FIX and FXI deficiencies.
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Affiliation(s)
- Mayken Visser
- From the Bayer AG, Cardiovascular Research, Wuppertal, Germany (M.V., V.L., S.H.)
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.V., R.v.O., H.t.C., H.M.H.S.)
| | - René van Oerle
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.V., R.v.O., H.t.C., H.M.H.S.)
| | - Hugo ten Cate
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.V., R.v.O., H.t.C., H.M.H.S.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany (H.t.C.)
| | - Volker Laux
- From the Bayer AG, Cardiovascular Research, Wuppertal, Germany (M.V., V.L., S.H.)
| | - Nigel Mackman
- Thrombosis and Hemostasis Program, Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Stefan Heitmeier
- From the Bayer AG, Cardiovascular Research, Wuppertal, Germany (M.V., V.L., S.H.)
| | - Henri M.H. Spronk
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.V., R.v.O., H.t.C., H.M.H.S.)
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Panova-Noeva M, van der Meijden PE, ten Cate H. Clinical Applications, Pitfalls, and Uncertainties of Thrombin Generation in the Presence of Platelets. J Clin Med 2019; 9:jcm9010092. [PMID: 31905839 PMCID: PMC7019916 DOI: 10.3390/jcm9010092] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022] Open
Abstract
Platelet-dependent thrombin generation is a helpful tool to assess ex vivo the interaction between platelets and plasma coagulation factors in the initiation, amplification, and inhibition of thrombin generation (TG). This review article discusses the most relevant available data on the clinical applications of fluorogenic TG, the most widely used TG assay, performed in the presence of platelets, i.e., in platelet-rich plasma. With respect to prothrombotic states, arterial hypertension and obesity were the most prominent cardiovascular conditions linked to increased platelet-dependent TG. In addition, platelet-associated hypercoagulability, assessed by the TG assay, has been shown in individuals with active cancer. In terms of bleeding, platelet-dependent TG has been applied to assess bleeding risk in individuals with hemophilia, von Willebrand disease, and Glanzmann thrombasthenia as well as in subjects with other congenital or acquired coagulation factor deficiencies. In addition to risk prediction, a role of the TG assay has been suggested in monitoring antiplatelet therapy in prothrombotic conditions and replacement therapy in bleeding diathesis. Finally, for the routine clinical use and as a biomarker of disease development and progression, better standardization and clinical validation of platelet-dependent TG are still needed.
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Affiliation(s)
- Marina Panova-Noeva
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
| | - Paola E.J. van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6200 Maastricht, The Netherlands;
| | - Hugo ten Cate
- Department of Internal Medicine, Laboratory of Clinical Thrombosis and Haemostasis, and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6200 Maastricht, The Netherlands
- Correspondence:
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Relation between platelet coagulant and vascular function, sex-specific analysis in adult survivors of childhood cancer compared to a population-based sample. Sci Rep 2019; 9:20090. [PMID: 31882836 PMCID: PMC6934665 DOI: 10.1038/s41598-019-56626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Female sex is a risk factor for long-term adverse outcome in cancer survivors, however very little is known for the underlying pathophysiological mechanisms rendering the increased risk. This study investigated sex-specifically the relation between thrombin generation (TG) with and without presence of platelets and vascular function in 200 adult survivors of a childhood cancer compared to 335 population-based control individuals. TG lag time, peak height and endogenous thrombin potential (ETP) measured in presence and absence of platelets were correlated to reflection index (RI) and stiffness index (SI). A sex-specific correlation analysis showed a negative relation in female survivors for platelet-dependent peak height and/or ETP and RI only. An age adjusted linear regression model confirmed the negative association between RI and platelet-dependent ETP (beta estimate: −6.85, 95% confidence interval: −12.19,−1.51) in females. Adjustment for cardiovascular risk factors resulted in loss of the association, whereby arterial hypertension and obesity showed the largest effects on the observed association. No other relevant associations were found in male and female cancer survivors and all population-based controls. This study demonstrates a link between platelet coagulant and vascular function of resistance vessels, found in female cancer survivors, potentially mediated by the presence of arterial hypertension and obesity.
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Nahain AA, Ignjatovic V, Monagle P, Tsanaktsidis J, Vamvounis G, Ferro V. Anticoagulant Heparin Mimetics via RAFT Polymerization. Biomacromolecules 2019; 21:1009-1021. [DOI: 10.1021/acs.biomac.9b01688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria 3010, Australia
- Department of Clinical Haematology, Royal Children’s Hospital, Parkville, Victoria 3052, Australia
| | - John Tsanaktsidis
- CSIRO Manufacturing, Research Way, Clayton, Victoria 3168, Australia
| | - George Vamvounis
- College of Science and Engineering, James Cook University, Townsville, Queensland 4811, Australia
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Calzavarini S, Brodard J, Quarroz C, Maire L, Nützi R, Jankovic J, Rotondo LC, Giabbani E, Fiedler GM, Nagler M, Angelillo‐Scherrer A. Thrombin generation measurement using the ST Genesia Thrombin Generation System in a cohort of healthy adults: Normal values and variability. Res Pract Thromb Haemost 2019; 3:758-768. [PMID: 31624796 PMCID: PMC6781929 DOI: 10.1002/rth2.12238] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/01/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Thrombin generation (TG) assays evaluate the balance between pro- and anticoagulant forces, to better assess bleeding and thrombotic risks. Although TG readouts obtained with the calibrated automated TG have been investigated in multiple clinical conditions, TG still needs standardization and clinical validation. The automated TG instrument ST Genesia® (STG, Stago, Asnières-sur-Seine, France) provides a normalization of TG parameters based on a reference plasma aiming to reduce the interlaboratory variability and the variability between different measurement runs. OBJECTIVES To evaluate STG in a group of healthy adults. METHODS Reference intervals in healthy adults and variability of the new standardized reagents for bleeding (BleedScreen) and thrombophilic (ThromboScreen) conditions were determined using STG. RESULTS TG was measured in platelet-free plasma (PFP) samples of 123 healthy adults. Reference intervals were determined for TG parameters. Intra- and interassay coefficients of variation were calculated on quality controls and PFP samples from healthy adults. Oral contraception (OC) possibly influenced TG parameters, resulting in a higher median and a broader reference interval for peak height and endogenous thrombin potential (ETP) in women aged 20 to 49 years than in all other sex and age categories. Therefore, we propose the following reference interval categories: men, women aged <50 years not using OC, women aged <50 years using OC, and women aged ≥50 years. Normalization was effective to reduce the interassay variability of quality controls for ETP (BleedScreen assay), and peak height and ETP (ThromboScreen assay without thrombomodulin), but had little impact on PFP sample variability. CONCLUSION STG appears suitable for accurate measurement of TG in healthy adults.
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Affiliation(s)
- Sara Calzavarini
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
- Department for BioMedical ResearchUniversity of BernBernSwitzerland
| | - Justine Brodard
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Claudia Quarroz
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
- Department for BioMedical ResearchUniversity of BernBernSwitzerland
| | - Livia Maire
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
- Department for BioMedical ResearchUniversity of BernBernSwitzerland
| | - Raphael Nützi
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Jovana Jankovic
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Laura C. Rotondo
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Evelyne Giabbani
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Georg Martin Fiedler
- Institute of Clinical ChemistryInselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Michael Nagler
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
- Department for BioMedical ResearchUniversity of BernBernSwitzerland
| | - Anne Angelillo‐Scherrer
- Department of Hematology and Central Hematology Laboratory, InselspitalBern University HospitalUniversity of BernBernSwitzerland
- Department for BioMedical ResearchUniversity of BernBernSwitzerland
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Douxfils J, Morimont L, Delvigne AS, Devel P, Masereel B, Haguet H, Bouvy C, Dogné JM. Validation and standardization of the ETP-based activated protein C resistance test for the clinical investigation of steroid contraceptives in women: an unmet clinical and regulatory need. ACTA ACUST UNITED AC 2019; 58:294-305. [DOI: 10.1515/cclm-2019-0471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/30/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Regulatory bodies recommend the use of an assay based on the assessment of the endogenous thrombin potential (ETP) for the investigation of the activated protein C resistance (APCr) in the development of steroid contraceptives in women. However, the assays described in the literature are home-made and not standardized regarding the method, the reagents, the reference plasma and the quality controls. In the absence of any commercially available method, we aimed at validating the ETP-based APCr assay.
Methods
The validation was performed according to regulatory standards. The method targets a 90% inhibition of the ETP in healthy donors in the presence of APC compared to the same condition in the absence of APC. As a large-scale production of a pool of plasma from well-selected healthy donors is impossible, algorithms were applied to a commercial reference plasma to correlate with the selected pool.
Results
Repeatability and intermediate precision passed the acceptance criteria. The assay demonstrated a curvilinear dose response to protein S and APC concentrations (R2 > 0.99). Analysis of plasma samples from 47 healthy individuals (22 women not taking combined hormonal contraceptives [CHC], and 25 men not Factor V Leiden carriers) confirmed the validity of the test, with a mean inhibition percentage of 90%. Investigations in 15 women taking different contraceptives and in two subjects with Factor V Leiden confirmed the good sensitivity and performance of the assay.
Conclusions
This validation provides the pharmaceutical industry, the regulatory bodies and physicians with a reproducible, sensitive and validated gold-standard ETP-based APCr assay.
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Affiliation(s)
- Jonathan Douxfils
- Qualiblood sa , Namur , Belgium
- University of Namur , Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences , Namur , Belgium
| | - Laure Morimont
- University of Namur , Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences , Namur , Belgium
| | | | - Philippe Devel
- University of Namur , Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences , Namur , Belgium
| | - Bernard Masereel
- Qualiblood sa , Namur , Belgium
- University of Namur , Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences , Namur , Belgium
| | - Hélène Haguet
- University of Namur , Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences , Namur , Belgium
| | | | - Jean-Michel Dogné
- University of Namur , Department of Pharmacy, Namur Thrombosis and Hemostasis Center, NAmur Research Institute for LIfe Sciences , Namur , Belgium
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Favresse J, Lippi G, Roy PM, Chatelain B, Jacqmin H, Ten Cate H, Mullier F. D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications. Crit Rev Clin Lab Sci 2019; 55:548-577. [PMID: 30694079 DOI: 10.1080/10408363.2018.1529734] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
D-dimer is a soluble fibrin degradation product deriving from the plasmin-mediated degradation of cross-linked fibrin. D-dimer can hence be considered a biomarker of activation of coagulation and fibrinolysis, and it is routinely used for ruling out venous thromboembolism (VTE). D-dimer is increasingly used to assess the risk of VTE recurrence and to help define the optimal duration of anticoagulation treatment in patients with VTE, for diagnosing disseminated intravascular coagulation, and for screening medical patients at increased risk of VTE. This review is aimed at (1) revising the definition of D-dimer; (2) discussing preanalytical variables affecting the measurement of D-dimer; (3) reviewing and comparing assay performance and some postanalytical variables (e.g. different units and age-adjusted cutoffs); and (4) discussing the use of D-dimer measurement across different clinical settings.
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Affiliation(s)
- Julien Favresse
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Giuseppe Lippi
- b Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
| | - Pierre-Marie Roy
- c Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC , Université d'Angers , Angers , France
| | - Bernard Chatelain
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugues Jacqmin
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugo Ten Cate
- d Department of Internal Medicine, Cardiovascular Institute , Maastricht University Medical Center , Maastricht , the Netherlands
| | - François Mullier
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
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Douxfils J, Morimont L, Bouvy C, de Saint‐Hubert M, Devalet B, Devroye C, Dincq A, Dogné J, Guldenpfennig M, Baudar J, Larock A, Lessire S, Mullier F. Assessment of the analytical performances and sample stability on ST Genesia system using the STG-DrugScreen application. J Thromb Haemost 2019; 17:1273-1287. [PMID: 31063645 PMCID: PMC6852561 DOI: 10.1111/jth.14470] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thrombin generation testing has been used to provide information on the coagulation phenotype of patients. The most used technique is the calibrated automated thrombogram (CAT) but it suffers from a lack of standardization, preventing its implementation in routine. The ST Genesia is a new analyzer designed to assess thrombin generation based on the same principle as the CAT. Unlike the CAT system, the ST Genesia is a benchtop, fully automated analyzer, able to perform the analyses individually and not by batch, with strict control of variables such as temperature and volumes, ensuring, theoretically, maximal reproducibility. OBJECTIVES This study aimed at assessing the performance of the STG-DrugScreen application on the ST Genesia analyzer. We also aimed at exploring stability of plasma samples after freezing and defining a reference normal range. RESULTS Results demonstrated the excellent interexperiment precision of the ST Genesia and confirmed that the use of a reference plasma helps reducing the inter-experiments variability. Stability revealed that plasma samples are stable for at least 11 months at -70°C or lower, except for those containing low molecular weight heparins which have to be tested within 6 months. Freezing had no effect on the majority of thrombin generation parameters except on time to peak. CONCLUSIONS Our results suggest an easy implementation of thrombin generation with the use of ST Genesia in the routine laboratory. This will facilitate the design of multicentric studies and enable the establishment of reliable and evidence-based thresholds, which may improve the management of patients treated with anticoagulants.
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Affiliation(s)
- Jonathan Douxfils
- Department of PharmacyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterUniversity of NamurNamurBelgium
- Qualiblood s.a.NamurBelgium
| | - Laure Morimont
- Department of PharmacyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterUniversity of NamurNamurBelgium
| | | | | | - Bérangère Devalet
- Department of HematologyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - Célia Devroye
- Hematology LaboratoryNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - Anne‐Sophie Dincq
- Department of AnesthesiologyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - Jean‐Michel Dogné
- Department of PharmacyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterUniversity of NamurNamurBelgium
| | - Maïté Guldenpfennig
- Hematology LaboratoryNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - Justine Baudar
- Hematology LaboratoryNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - Anne‐Sophie Larock
- Department of PharmacyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - Sarah Lessire
- Department of AnesthesiologyNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
| | - François Mullier
- Hematology LaboratoryNamur Research Institute for Life SciencesNamur Thrombosis and Hemostasis CenterCHU UCL NamurUniversité catholique de LouvainYvoirBelgium
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Negrier C, Shima M, Hoffman M. The central role of thrombin in bleeding disorders. Blood Rev 2019; 38:100582. [PMID: 31164248 DOI: 10.1016/j.blre.2019.05.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 01/25/2023]
Abstract
Maintaining normal hemostasis relies on a regulated system of procoagulant and anticoagulant pathways, and disruption of these processes leads to the loss of hemostatic control, with the potential for excessive bleeding or thrombosis. Evaluation of bleeding disorders has conventionally been achieved by laboratory assays that measure the activity of individual coagulation factors. While such assays have proven effective for detecting abnormalities of the coagulation system and aiding diagnosis, inherent limitations prevent them from capturing a complete picture of hemostatic function. An improved understanding of thrombin activity and its central role in hemostasis and bleeding disorders has led to the clinical development of global assays that are more physiologically relevant than traditional assays; furthermore, these global assays are able to monitor responses to therapy. In this review, we provide an overview of the role of thrombin in hemostasis, and describe the clinical benefits of thrombin monitoring in patients with bleeding disorders. Moreover, we discuss recent advances in thrombin-targeting therapeutic strategies that aim to correct thrombin deficiency and prevent bleeding in patients with hemophilia and other rare bleeding disorders.
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Affiliation(s)
- Claude Negrier
- Haematology Department, Louis Pradel University Hospital, University Claude Bernard, Lyon, France
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Maureane Hoffman
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
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Lim HY, O'Malley C, Donnan G, Nandurkar H, Ho P. A review of global coagulation assays - Is there a role in thrombosis risk prediction? Thromb Res 2019; 179:45-55. [PMID: 31078120 DOI: 10.1016/j.thromres.2019.04.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 01/27/2023]
Abstract
Normal haemostasis requires maintenance of a careful equilibrium between the necessity to clot when bleeding and the retention of fluid phase at all other times. Disruption of this equilibrium can result in catastrophic outcomes, e.g. acute myocardial infarction and pulmonary embolism. However, despite the significant therapeutic advances in cardiovascular medicine over recent years, our ability to provide an accurate cardiovascular risk assessment remains an unmet need. Routine coagulation testing is not a useful reflection of haemostasis and cannot be reliably used to predict bleeding and thrombosis risks. Global coagulation assays such as viscoelastic testing, thrombin and fibrin generation have been proposed as better measures of the haemostatic function. These assays, particularly viscoelastic testing, have been increasingly used to assess bleeding risks and guide blood product replacement in trauma and massive transfusion settings. However, the role of these assays in thrombosis is less well-defined but given the complexities of the coagulation system, these global coagulation assays when used in combination may provide a better assessment of cardiovascular and thrombosis risk at an individual level. Hence, we explore the role of some of the currently available global coagulation assays - the viscoelastic, thrombin generation and fibrin generation tests - and provide a review of the literature of the current evidence for these assays specifically in the field of venous thromboembolism and cardiovascular diseases.
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Affiliation(s)
- Hui Yin Lim
- Department of Haematology, Northern Hospital, 185 Cooper St, Epping, VIC 3076, Australia; Australian Centre for Blood Diseases, Monash University, Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade (corner Genetics Lane), Parkville, VIC 3052, Australia.
| | - Cindy O'Malley
- RMIT University, Plenty Road, Bundoora, VIC 3083, Australia
| | - Geoffrey Donnan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade (corner Genetics Lane), Parkville, VIC 3052, Australia
| | - Harshal Nandurkar
- Australian Centre for Blood Diseases, Monash University, Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Hospital, 185 Cooper St, Epping, VIC 3076, Australia; Australian Centre for Blood Diseases, Monash University, Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade (corner Genetics Lane), Parkville, VIC 3052, Australia
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Thrombin generation in different commercial sodium citrate blood tubes. J Med Biochem 2019; 39:19-24. [PMID: 32549773 DOI: 10.2478/jomb-2019-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/04/2019] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to verify whether blood drawn into six different commercial coagulation tubes generated comparable results of thrombin generation. Methods Blood was sequentially collected from 20 healthy subjects into different brand and draw volume 3.2% sodium citrate tubes (4.3 mL Sarstedt, 3.0 mL Greiner, 2.7 mL Becton Dickinson, 2.0 mL Kima, 1.8 mL Sarstedt and 1.0 mL Greiner). Thrombin generation was measured in plasma with the fully-automated ST Genesia analyzer using the weakest trigger (STG-BleedScreen). Results Different values of lag time (LT), time to reach thrombin peak (TP), thrombin peak height (PH) and endogenous thrombin potential (ETP) were commonly found in different tubes. Thrombin generation was the lowest in 4.3 mL Sarstedt tubes and the highest in 1.0 mL Greiner tubes. Other tubes displayed intermediate values. In multiple comparisons, LT was significantly different in 6/15 cases (40%), whilst PH, TP and ETP were significantly different in 14/15 (93%), 13/15 (87%) and 13/15 (87%) cases. The mean percent bias of LT, PH, TP and ETP ranged between -6% and +1%, -27% and +116%, -22% and +8%, and between -18% and +65%. The intra-assay imprecision of LT, PH, TP and ETP was exceeded in 0/15 (0%), 13/15 (87%), 6/15 (40%) and 13/15 (87%) comparisons. The correlation of LT, PH, TP and ETP values in different tubes ranged between 0.718-0.971, 0.570-0.966, 0.725-0.977 and 0.101-0.904. Conclusions Blood collection for thrombin generation assays requires local standardization using identical tubes for brand and draw volume, and reference ranges calculated according to type of tubes.
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Ljungkvist M, Strandberg K, Berntorp E, Chaireti R, Holme PA, Larsen OH, Lassila R, Jouppila A, Szanto T, Zetterberg E. Evaluation of a standardized protocol for thrombin generation using the calibrated automated thrombogram: A Nordic study. Haemophilia 2019; 25:334-342. [DOI: 10.1111/hae.13640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Marcus Ljungkvist
- Department of Translational Medicine & Centre for Thrombosis and Haemostasis Lund University Malmö Sweden
| | - Karin Strandberg
- Clinical Chemistry University and Regional Laboratories Region Scania Malmö Sweden
| | - Erik Berntorp
- Department of Translational Medicine & Centre for Thrombosis and Haemostasis Lund University Malmö Sweden
| | - Roza Chaireti
- Department of Hematology Karolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Pål André Holme
- Department of Haematology, Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Ole Halfdan Larsen
- Centre for Haemophilia and Thrombosis Aarhus University Hospital Skejby Denmark
| | - Riitta Lassila
- Unit of Coagulation Disorders, Department of Hematology Helsinki University Central Hospital Helsinki Finland
| | - Annukka Jouppila
- Helsinki University Central Hospital Research Institute Helsinki Finland
| | - Timea Szanto
- Unit of Coagulation Disorders, HUSLAB Laboratory Services, Department of Clinical Chemistry Helsinki University Hospital Helsinki Finland
| | - Eva Zetterberg
- Department of Translational Medicine & Centre for Thrombosis and Haemostasis Lund University Malmö Sweden
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Duarte RCF, Rios DRA, Rezende SM, Jardim LL, Ferreira CN, Carvalho MDG. Standardization and evaluation of the performance of the thrombin generation test under hypo- and hypercoagulability conditions. Hematol Transfus Cell Ther 2018; 41:244-252. [PMID: 31085150 PMCID: PMC6732533 DOI: 10.1016/j.htct.2018.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/19/2018] [Accepted: 08/13/2018] [Indexed: 12/03/2022] Open
Abstract
Background In order to standardize a thrombin generation() protocol, we analyzed the analytical variables and sensitivity of this test to hypo/hypercoagulability states. Methods The effect of the tissue factor concentration and the intra- and interassay precision were analyzed. To evaluate the hypercoagulability status, the plasma of women under an oral contraceptive was tested, while plasma from hemophilia A patients at 1, 3 and 7 days after recombinant FVIII infusion, and lyophilized plasma deficient in FVII or FVIII were used for the evaluation of hypocoagulability. Results The intra-assay coefficient of variation was <10% with 1 and 5 pM of low and high TF. The oral contraceptive users showed increased thrombin generation in comparison to non-users, which was more pronounced with low TF (endogenous thrombin potential ETP) p = 0.0009; peak p = 0.0009; lagtime p = 0.0008). In relation to the FVIII-deficient plasma, a higher TG was observed as FVIII levels were increased and a better discrimination was obtained for different concentrations of FVIII with low TF (ETP p < 0.0001; peak p < 0.0001; lagtime p = 0.0004). Using low TF, plasma from hemophilia A patients showed higher TG values after 1 day of recombinant FVIII infusion vs after 3 days (ETP p < 0.0001; peak p < 0.0001; lagtime p = 0.0407), while the lowest values were observed after 7 days. With FVII-deficient plasma, thrombin generation was lower than normal plasma and a more pronounced difference was observed with high TF compared to low TF (ETP p < 0.0001; peak p < 0.0001; lagtime p < 0.0001). Conclusion Under our conditions the thrombin generation test seems to be sensitive to evaluation of hyper/hypocoagulability states. Standardization of the thrombin generation test may have an application in the evaluation of bleeding and thrombotic disorders.
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73
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Govorov I, Bremme K, Lindahl TL, Holmström M, Komlichenko E, Chaireti R, Mints M. Thrombin generation during a regular menstrual cycle in women with von Willebrand disease. Sci Rep 2018; 8:17467. [PMID: 30504807 PMCID: PMC6269516 DOI: 10.1038/s41598-018-35897-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/07/2018] [Indexed: 11/09/2022] Open
Abstract
Fluctuations of the sex steroids during the menstrual cycle might significantly influence hemostasis. This association, derived from a number of the observations on healthy women, is yet to be described in females affected by bleeding disorders. The aim of the current study was to assess the changes in hemostatic variables in women with vWD during two phases of the menstrual cycle (follicular and luteal) and to compare it with healthy controls. The study group included 12 vWD-affected females with regular menstrual cycle, with none of them being prescribed any hormonal treatment. The control group consisted of 102 healthy females, matched for age and BMI. Within the vWD group FVIII and FX were both significantly higher during follicular phase than in luteal phase (p = 0.013 and p = 0.033 respectively). AT, FII, FVII and FX were higher in women with vWD, compared with controls during both phases of the menstrual cycle (p < 0.0005, p < 0.0005, p = 0.001 and p < 0.0005). In women with vWD, lag time and time to peak were prolonged during both phases of the menstrual cycle(p < 0.0005), while peak thrombin concentration was reduced (p = 0.003 and p = 0.002 during follicular and luteal phase respectively) compared to healthy peers. Lower levels of FVIII and FX during luteal phase may predispose women to the development of the menorrhagia - common complication of vWD. Women with vWD need more time to reach the peak thrombin concentration, while the latter still remains less than in healthy women. Higher levels of AT in vWD-affected females, compared to controls, may also contribute to the existing bleeding tendency in this cohort.
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Affiliation(s)
- Igor Govorov
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Katarina Bremme
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Tomas L Lindahl
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Margareta Holmström
- Department of Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Eduard Komlichenko
- Institution of Pediatrics and Perinatology, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Roza Chaireti
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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74
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Cardiovascular risk factors are important determinants of platelet-dependent thrombin generation in adult survivors of childhood cancer. Clin Res Cardiol 2018; 108:438-447. [DOI: 10.1007/s00392-018-1374-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
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75
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Ravanat C, Dupuis A, Marpaux N, Naegelen C, Mourey G, Isola H, Laforêt M, Morel P, Gachet C. In vitro
quality of amotosalen‐
UVA
pathogen‐inactivated mini‐pool plasma prepared from whole blood stored overnight. Vox Sang 2018; 113:622-631. [DOI: 10.1111/vox.12697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Catherine Ravanat
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | - Arnaud Dupuis
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | | | | | - Guillaume Mourey
- EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
- Université Bourgogne Franche Comté INSERM EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
| | - Herve Isola
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | - Michel Laforêt
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
| | - Pascal Morel
- EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
- Université Bourgogne Franche Comté INSERM EFS Bourgogne‐Franche‐Comté UMR1098 Besançon France
| | - Christian Gachet
- Université de Strasbourg INSERM EFS Grand‐Est BPPS UMR‐S1255 FMTS Strasbourg France
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76
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Krekels JPM, Verhezen PWM, Henskens YMC. Platelet Aggregation in Healthy Participants is Not Affected by Smoking, Drinking Coffee, Consuming a High-Fat Meal, or Performing Physical Exercise. Clin Appl Thromb Hemost 2018; 25:1076029618782445. [PMID: 29916260 PMCID: PMC6714925 DOI: 10.1177/1076029618782445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Platelet aggregation can be measured using optical aggregation (light transmission
aggregometry, LTA) as well as by impedance (Multiplate analyzer). The LTA (the gold
standard method) can be influenced by many preanalytical variables. Several guidelines
differ in recommendations for the duration patients should refrain from smoking, coffee,
fatty meals, and physical exercise prior to blood collection for performing platelet
function tests. In this pilot study, the influence of smoking, coffee, high-fat meal, or
physical exercise on platelet aggregation was investigated to improve patient friendliness
and laboratory logistics in platelet function diagnostics. Standardized blood collection
was performed when participants were fasting and after each parameter (n=5 per group). As
a control for diurnal fluctuations, participants (n=6) were fasting during both blood
collections. Platelet aggregation was executed using standardized methods for LTA and
Multiplate analyzer. Statistical analysis of the results using Wilcoxon signed-rank test
did not show any significant differences in platelet aggregation in healthy participants
under different preanalytical variables. Therefore, these variables are not expected to
adversely affect testing, which can avoid canceling tests for those patients who
inevitably did.
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Affiliation(s)
- Joyce P M Krekels
- 1 Central Diagnostic Laboratory, Cluster for Hemostasis and Transfusion, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Paul W M Verhezen
- 1 Central Diagnostic Laboratory, Cluster for Hemostasis and Transfusion, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Yvonne M C Henskens
- 1 Central Diagnostic Laboratory, Cluster for Hemostasis and Transfusion, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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77
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Cuq B, Blois SL, Wood RD, Monteith G, Abrams-Ogg AC, Bédard C, Wood GA. Reproducibility, stability, and biological variability of thrombin generation using calibrated automated thrombography in healthy dogs. Vet Clin Pathol 2018; 47:218-226. [DOI: 10.1111/vcp.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Benoît Cuq
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Shauna L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - R. Darren Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Gabrielle Monteith
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Anthony C. Abrams-Ogg
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Christian Bédard
- Département de Pathologie et Microbiologie; Faculté de Médecine Vétérinaire; Université de Montréal; Montreal QC Canada
| | - Geoffrey A. Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
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Comuth WJ, Henriksen LØ, van de Kerkhof D, Husted SE, Kristensen SD, de Maat MPM, Münster AMB. Comprehensive characteristics of the anticoagulant activity of dabigatran in relation to its plasma concentration. Thromb Res 2018; 164:32-39. [PMID: 29475179 DOI: 10.1016/j.thromres.2018.02.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Issues with laboratory measurement of dabigatran include: 1. Do coagulation assays reflect dabigatran plasma concentrations? 2. Do samples from patients treated with dabigatran have the same coagulability as dabigatran-spiked samples from healthy volunteers? 3. What is the long-term stability of dabigatran after storage at -80 °C? This study aims to evaluate these questions. MATERIALS AND METHODS Ecarin chromogenic assay (ECA), a laboratory-developed diluted thrombin time (LD-dTT), prothrombin time (PT) and activated partial thromboplastin time (APTT) and ROTEM® were used to measure dabigatran anticoagulant activity and liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure dabigatran plasma concentrations. ROTEM® (EXTEM, INTEM, FIBTEM) was performed in whole blood and the other assays in platelet poor plasma (PPP), both in samples spiked with dabigatran (0, 25, 50, 100, 250, 500 and 1000 ng/mL) from healthy donors and in ex vivo samples from patients treated with dabigatran etexilate. Citrated PPP samples were frozen and stored at -80 °C, 1, 3, 6 and 12 months until analysis. RESULTS EXTEM and FIBTEM clotting time (CT), ECA and LD-dTT correlate well with dabigatran plasma concentrations. With the exception of few ROTEM® parameters, there were no differences between spiked and patient samples. Samples were stable for at least 12 months at -80 °C. CONCLUSIONS EXTEM and FIBTEM CT, ECA and LD-dTT are suitable for measuring the effect of dabigatran in treated patients. In general, results from spiked plasma samples are similar to those of patient samples. Storage of dabigatran plasma samples for up to 12 months does not influence measured levels.
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Affiliation(s)
- Willemijn J Comuth
- Department of Clinical Biochemistry, Hospital Unit West, Herning, Holstebro, Denmark; Department of Cardiology, Hospital Unit West, Herning, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Linda Ø Henriksen
- Department of Clinical Biochemistry, Hospital Unit West, Herning, Holstebro, Denmark
| | - Daan van de Kerkhof
- Department of Clinical Biochemistry, Catharina Hospital, Eindhoven, The Netherlands
| | - Steen E Husted
- Department of Cardiology, Hospital Unit West, Herning, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steen D Kristensen
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Moniek P M de Maat
- Department of Haematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anna-Marie B Münster
- Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark; Unit for Thrombosis Research, Esbjerg, Denmark
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Abstract
The fundamental pathology in Alzheimer's disease (AD) is neuronal dysfunction leading to cognitive impairment. The amyloid-β peptide (Aβ), derived from amyloid precursor protein, is one driver of AD, but how it leads to neuronal dysfunction is not established. In this Review, I discuss the complexity of AD and possible cause-and-effect relationships between Aβ and the vascular and hemostatic systems. AD can be considered a multifactorial syndrome with various contributing pathological mechanisms. Therefore, as is routinely done with cancer, it will be important to classify patients with respect to their disease signature so that specific pathologies, including vascular pathways, can be therapeutically targeted.
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80
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Kristensen AF, Kristensen SR, Falkmer U, Münster AMB, Pedersen S. Analytical and between-subject variation of thrombin generation measured by calibrated automated thrombography on plasma samples. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:175-179. [PMID: 29336181 DOI: 10.1080/00365513.2018.1427280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Calibrated Automated Thrombography (CAT) is an in vitro thrombin generation (TG) assay that holds promise as a valuable tool within clinical diagnostics. However, the technique has a considerable analytical variation, and we therefore, investigated the analytical and between-subject variation of CAT systematically. Moreover, we assess the application of an internal standard for normalization to diminish variation. METHODS 20 healthy volunteers donated one blood sample which was subsequently centrifuged, aliquoted and stored at -80 °C prior to analysis. The analytical variation was determined on eight runs, where plasma from the same seven volunteers was processed in triplicates, and for the between-subject variation, TG analysis was performed on plasma from all 20 volunteers. The trigger reagents used for the TG assays included both PPP reagent containing 5 pM tissue factor (TF) and PPPlow with 1 pM TF. Plasma, drawn from a single donor, was applied to all plates as an internal standard for each TG analysis, which subsequently was used for normalization. RESULTS The total analytical variation for TG analysis performed with PPPlow reagent is 3-14% and 9-13% for PPP reagent. This variation can be minimally reduced by using an internal standard but mainly for ETP (endogenous thrombin potential). The between-subject variation is higher when using PPPlow than PPP and this variation is considerable higher than the analytical variation. CONCLUSION TG has a rather high inherent analytical variation but considerable lower than the between-subject variation when using PPPlow as reagent.
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Affiliation(s)
- Anne F Kristensen
- a Department of Clinical Biochemistry , Aalborg University Hospital , Aalborg , Denmark.,b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Søren R Kristensen
- a Department of Clinical Biochemistry , Aalborg University Hospital , Aalborg , Denmark.,b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Ursula Falkmer
- b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark.,c Department of Oncology , Aalborg University Hospital , Aalborg , Denmark
| | - Anna-Marie B Münster
- d Department of Clinical Biochemistry , Hospital Unit West , Holstebro , Denmark
| | - Shona Pedersen
- a Department of Clinical Biochemistry , Aalborg University Hospital , Aalborg , Denmark.,b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
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81
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Gram AS, Petersen MB, Quist JS, Rosenkilde M, Stallknecht B, Bladbjerg EM. Effects of 6 Months of Active Commuting and Leisure-Time Exercise on Fibrin Turnover in Sedentary Individuals with Overweight and Obesity: A Randomised Controlled Trial. J Obes 2018; 2018:7140754. [PMID: 29887998 PMCID: PMC5977059 DOI: 10.1155/2018/7140754] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/05/2018] [Accepted: 04/15/2018] [Indexed: 12/11/2022] Open
Abstract
Obesity and exercise constitute important factors for cardiovascular disease risk, but the long-term effects of different exercise modalities on haemostatic biomarkers are not well elucidated. We investigated the effects of 6 months of active commuting or leisure-time exercise on measures of fibrin turnover in individuals who are overweight and obese. Ninety younger (20-40 years), sedentary, healthy women and men who are overweight and obese (BMI: 25-35 kg/m2) were randomised to 6 months of habitual lifestyle (CON, n=16), active commuting (BIKE, n=19), or leisure-time exercise of moderate (MOD, ∼50% VO2peak reserve, n=31) or vigorous intensity (VIG, ∼70% VO2peak reserve, n=24). Fasting blood samples (baseline and 3 and 6 months) were analysed for cholesterols and triglycerides, thrombin generation, prothrombin fragment 1 + 2, D-dimer, fibrin clot properties, and fibrinolytic activity. We observed no differences between CON, BIKE, MOD, and VIG during the intervention and no time effects for any of the variables measured despite increased VO2peak in all exercise groups. We found no difference between CON and all exercise groups combined and no gender-specific effects of exercise. Our findings suggest that thrombin generation capacity, coagulation activation, fibrin clot structure, and lysability are unaffected by long-term active commuting and leisure-time exercise in women and men who are overweight and obese.
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Affiliation(s)
- Anne Sofie Gram
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Bæk Petersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Salling Quist
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Rosenkilde
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Else-Marie Bladbjerg
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
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Kintigh J, Monagle P, Ignjatovic V. A review of commercially available thrombin generation assays. Res Pract Thromb Haemost 2018; 2:42-48. [PMID: 30046705 PMCID: PMC6055498 DOI: 10.1002/rth2.12048] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/06/2017] [Indexed: 11/12/2022] Open
Abstract
Currently there are three commercially available thrombin generation methods. These methods help detect the levels of thrombin generated in patient samples by the use of chromogenic or fluorogenic substrates in plasma or whole blood. Determining the rate of thrombin generation can help indicate if patients are at risk of clotting or bleeding. This review discusses two fluorogenic and one chromogenic method and focuses on similarities and differences of these three methods. The review specifically focuses on the accuracy of commercial substrates used in thrombin generation, and interference that can occur by various plasma proteins, as well as on evaluating the advantages and disadvantages of each method. The commercial chromogenic assay and both fluorogenic assays are able to monitor the rate of thrombin generation and can give indications towards potential coagulation abnormalities. Overall, the main differences between the thrombin generation methods are based on the type of substrate used, sample preparation, and data processing. Despite advancement in this field there are still technical challenges that preclude the widespread use of thrombin generation in clinical applications.
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Affiliation(s)
- Jeremy Kintigh
- Haematology ResearchMurdoch Children's Research InstituteMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | - Paul Monagle
- Haematology ResearchMurdoch Children's Research InstituteMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
- Clinical HaematologyRoyal Children's HospitalMelbourneVic.Australia
| | - Vera Ignjatovic
- Haematology ResearchMurdoch Children's Research InstituteMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
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83
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Schneider T, Siegemund T, Siegemund R, Petros S. Thrombin generation and rotational thromboelastometry in the healthy adult population. Hamostaseologie 2017; 35:181-6. [DOI: 10.5482/hamo-14-08-0033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/05/2014] [Indexed: 11/05/2022] Open
Abstract
SummaryPublished data on thrombin generation variables and their correlation with thrombo - elastometry in the healthy population are scarce. This study aimed at assessing thrombin generation in adults and its correlation to classical rotational thromboelastometry (ROTEM).Thrombin generation was measured in platelet-poor plasma from healthy volunteers using the calibrated automated thrombogram (CAT) with 1 and 5 pmol/l tissue factor final concentration. Lag time, thrombin peak, time to thrombin peak and endogenous thrombin potential (ETP) were analyzed. ROTEM was performed without activator (NATEM) and data for clotting time, alpha angle, clot formation time and maximum clot firmness were correlated with those of thrombin generation.Altogether 132 persons (72 men, 60 women; median age: 48.0 years) were included. There was a positive non-linear correlation for age versus lag time (p < 0.001) and time to peak (p = 0.001), and almost linear correlation for age versus thrombin peak (p = 0.024) and ETP (p = 0.001), although with a moderate regression slope. Regarding ROTEM, there was a positive correlation between age and maximum clot firmness and alpha angle (p = 0.001), but a negative correlation between age and clotting time (p = 0.039). Comparing both assays, thrombin peak and ETP measured with a final tissue factor concentration of 5 pmol/l correlated significantly with alpha angle and maximum clot firmness.The age-related changes in CAT and ROTEM variables among adults are not linear. There is a significant correlation, although with a moderate slope, between data from CAT measured with 5 pmol/l tissue factor and ROTEM.
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84
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Correlation to FVIII:C in Two Thrombin Generation Tests: TGA-CAT and INNOVANCE ETP. Mediterr J Hematol Infect Dis 2017; 9:e2017064. [PMID: 29181141 PMCID: PMC5667533 DOI: 10.4084/mjhid.2017.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction Several thrombin-generation tests are available, but few have been directly compared. Our primary aim was to investigate the correlation of two thrombin generation tests, thrombin generation assay-calibrated automated thrombogram (TGA-CAT) and INNOVANCE ETP, to factor VIII levels (FVIII:C) in a group of patients with hemophilia A. The secondary aim was to investigate inter-laboratory variation for the TGA-CAT method. Methods Blood samples were taken from 45 patients with mild, moderate and severe hemophilia A. The TGA-CAT method was performed at both centers while the INNOVANCE ETP was only performed at the Stockholm center. Correlation between parameters was evaluated using Spearman's rank correlation test. For determination of the TGA-CAT inter-laboratory variability, Bland-Altman plots were used. Results The correlation for the INNOVANCE ETP and TGA-CAT methods with FVIII:C in persons with hemophilia (PWH) was r=0.701 and r=0.734 respectively.The correlation between the two methods was r=0.546.When dividing the study material into disease severity groups (mild, moderate and severe) based on FVIII levels, both methods fail to discriminate between them.The variability of the TGA-CAT results performed at the two centers was reduced after normalization; before normalization, 29% of values showed less than ±10% difference while after normalization the number increased to 41%. Conclusions Both methods correlate in an equal manner to FVIII:C in PWH but show a poor correlation with each other. The level of agreement for the TGA-CAT method was poor though slightly improved after normalization of data. Further improvement of standardization of these methods is warranted.
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85
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Brooks MB, Stablein AP, Johnson L, Schultze AE. Preanalytic processing of rat plasma influences thrombin generation and fibrinolysis assays. Vet Clin Pathol 2017; 46:496-507. [DOI: 10.1111/vcp.12534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Marjory B. Brooks
- Departments of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Alyssa P. Stablein
- Departments of Population Medicine and Diagnostic Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Lynn Johnson
- Cornell Statistical Consulting Unit; Cornell University; Ithaca NY USA
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Tóth J, Debreceni IB, Deák Á, Pető K, Berhés M, Hajdú E, Szabó J, Németh N, Fülesdi B, Kappelmayer J. Characteristics of thrombin generation in a fulminant porcine sepsis model. Thromb Res 2017; 158:25-34. [PMID: 28802974 DOI: 10.1016/j.thromres.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/06/2017] [Accepted: 07/31/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The activation of blood coagulation has been demonstrated in most cases of sepsis, however previous studies in humans could not detect hypercoagulability with global hemostasis assays. In a fulminant porcine sepsis model we analysed coagulation screening tests and thrombin generation to evaluate hemostatic alterations. MATERIALS AND METHODS Live Escherichia coli bacteria were inoculated to female pigs and prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen were measured by coagulometry. Platelet counts, platelet aggregates and platelet phosphatidyl serine (PS) expression were studied, furthermore in in vitro experiments the PS-inducing ability of septic and control plasmas was investigated by flow cytometry. Thrombin generation was carried out by the Ascent Fluoroscan reader and results were evaluated by the Thrombinoscope software. RESULTS Clotting assays showed a large variability, but no systematic changes during the 4-hour observation period. Platelet count significantly decreased and the number of platelet aggregates increased already by 2h compared to baseline values and to control animals. Although the increase in platelet PS expression was non-significant in the septic group, the septic plasma elicited PS expression on normal human red blood cells. Thrombin generation became significantly faster, but the quantity of formed thrombin demonstrated both hypo- and hypercoagulability depending on the setting of the assay. CONCLUSIONS Enhanced thrombin generation without activators and the PS-inducing capacity of septic plasma are signs of hemostatic activation during fulminant sepsis while the decreased amount of generated thrombin upon tissue factor and phospholipid induced activation demonstrates attenuated thrombin forming ability.
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Affiliation(s)
- Judit Tóth
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Beke Debreceni
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ádám Deák
- Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Pető
- Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Mariann Berhés
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre Hajdú
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Szabó
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Németh
- Department of Operative Techniques and Surgical Research, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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87
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Bloemen S, Huskens D, Konings J, Kremers RM, Miszta A, de Laat B, Kelchtermans H. Interindividual Variability and Normal Ranges of Whole Blood and Plasma Thrombin Generation. ACTA ACUST UNITED AC 2017; 2:150-164. [DOI: 10.1373/jalm.2017.023630] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/02/2017] [Indexed: 11/06/2022]
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88
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Kleinegris MCF, Konings J, Daemen JW, Henskens Y, de Laat B, Spronk HMH, Ten Cate-Hoek AJ, Ten Cate H. Increased Clot Formation in the Absence of Increased Thrombin Generation in Patients with Peripheral Arterial Disease: A Case-Control Study. Front Cardiovasc Med 2017; 4:23. [PMID: 28473975 PMCID: PMC5397513 DOI: 10.3389/fcvm.2017.00023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/31/2017] [Indexed: 11/22/2022] Open
Abstract
Background In peripheral arterial disease (PAD), activation of the hemostatic system may contribute to atherosclerosis progression and atherothrombotic events. Objective This case–control study assesses the overall coagulation status in PAD patients by evaluating coagulation markers in combination with thrombin generation potential, whole blood (WB) clot formation, and fibrinolysis. Methods In blood from 40 PAD patients (n = 20 with cardiovascular event within 1 year after initial diagnosis, n = 20 without) and 40 apparently healthy controls, thrombin generation was determined in WB and platelet-poor plasma. Whole blood rotational thromboelastometry (ROTEM) measurements were triggered with tissue factor with/without tissue plasminogen activator. Results We observed increased levels of erythrocyte sedimentation rate, leukocytes, eosinophil granulocytes, vWF antigen, fibrinogen, and D-dimer in PAD patients (p < 0.05). Markers of thrombin generation potential showed no difference between patients and healthy controls. In PAD patients with event compared to patients without, WB-thrombin generation showed a lower thrombin potential when triggered with 0 and 2.5 pM tissue factor. The ROTEM clotting assay showed significantly faster clot formation and increased clot firmness in PAD patients compared to controls. No significant differences were found for parameters of clot degradation. Conclusion There are no significant differences between the thrombin generation profiles of PAD patients and healthy controls. Between PAD patients with and without cardiovascular event, the WB thrombin generation appears to differ. Mechanistically, PAD patients show an increased ability to form a stable clot in WB in comparison to healthy controls. This is most likely due to the increased fibrinogen levels related to the inflammation in atherosclerosis, confirming the importance of the inflammation-coagulation axis.
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Affiliation(s)
- Marie-Claire F Kleinegris
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joke Konings
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.,Synapse BV, Maastricht, Netherlands
| | - Jan W Daemen
- Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Yvonne Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bas de Laat
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.,Synapse BV, Maastricht, Netherlands
| | - Henri M H Spronk
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arina J Ten Cate-Hoek
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Hugo Ten Cate
- Laboratory for Clinical Thrombosis and Hemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
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89
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Magnette A, Chatelain M, Chatelain B, Ten Cate H, Mullier F. Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories. Thromb J 2016; 14:49. [PMID: 27999475 PMCID: PMC5154122 DOI: 10.1186/s12959-016-0123-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
Ensuring quality has become a daily requirement in laboratories. In haemostasis, even more than in other disciplines of biology, quality is determined by a pre-analytical step that encompasses all procedures, starting with the formulation of the medical question, and includes patient preparation, sample collection, handling, transportation, processing, and storage until time of analysis. This step, based on a variety of manual activities, is the most vulnerable part of the total testing process and is a major component of the reliability and validity of results in haemostasis and constitutes the most important source of erroneous or un-interpretable results. Pre-analytical errors may occur throughout the testing process and arise from unsuitable, inappropriate or wrongly handled procedures. Problems may arise during the collection of blood specimens such as misidentification of the sample, use of inadequate devices or needles, incorrect order of draw, prolonged tourniquet placing, unsuccessful attempts to locate the vein, incorrect use of additive tubes, collection of unsuitable samples for quality or quantity, inappropriate mixing of a sample, etc. Some factors can alter the result of a sample constituent after collection during transportation, preparation and storage. Laboratory errors can often have serious adverse consequences. Lack of standardized procedures for sample collection accounts for most of the errors encountered within the total testing process. They can also have clinical consequences as well as a significant impact on patient care, especially those related to specialized tests as these are often considered as "diagnostic". Controlling pre-analytical variables is critical since this has a direct influence on the quality of results and on their clinical reliability. The accurate standardization of the pre-analytical phase is of pivotal importance for achieving reliable results of coagulation tests and should reduce the side effects of the influence factors. This review is a summary of the most important recommendations regarding the importance of pre-analytical factors for coagulation testing and should be a tool to increase awareness about the importance of pre-analytical factors for coagulation testing.
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Affiliation(s)
- A Magnette
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| | - M Chatelain
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| | - B Chatelain
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
| | - H Ten Cate
- Maastricht University Medical Centre and Cardiovascular Research Institute (CARIM), Department of Internal Medicine, Maastricht, The Netherlands
| | - F Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), NARILIS, Haematology Laboratory, B-5530 Yvoir, Belgium
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90
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Loeffen R, van Oerle R, Leers MPG, Kragten JA, Crijns H, Spronk HMH, ten Cate H. Factor XIa and Thrombin Generation Are Elevated in Patients with Acute Coronary Syndrome and Predict Recurrent Cardiovascular Events. PLoS One 2016; 11:e0158355. [PMID: 27419389 PMCID: PMC4946779 DOI: 10.1371/journal.pone.0158355] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/14/2016] [Indexed: 11/26/2022] Open
Abstract
Objective In acute coronary syndrome (ACS) cardiac cell damage is preceded by thrombosis. Therefore, plasma coagulation markers may have additional diagnostic relevance in ACS. By using novel coagulation assays this study aims to gain more insight into the relationship between the coagulation system and ACS. Methods We measured plasma thrombin generation, factor XIa and D-dimer levels in plasma from ACS (n = 104) and non-ACS patients (n = 42). Follow-up measurements (n = 73) were performed at 1 and 6 months. Associations between coagulation markers and recurrent cardiovascular events were calculated by logistic regression analysis. Results Thrombin generation was significantly enhanced in ACS compared to non-ACS patients: peak height 148±53 vs. 122±42 nM. There was a significantly diminished ETP reduction (32 vs. 41%) and increased intrinsic coagulation activation (25 vs. 7%) in ACS compared to non-ACS patients. Furthermore, compared to non-ACS patients factor XIa and D-dimer levels were significantly elevated in ACS patients: 1.9±1.1 vs. 1.4±0.7 pM and 495(310–885) vs. 380(235–540) μg/L. Within the ACS spectrum, ST-elevated myocardial infarction patients had the highest prothrombotic profile. During the acute event, thrombin generation was significantly increased compared to 1 and 6 months afterwards: peak height 145±52 vs. 100±44 vs. 98±33 nM. Both peak height and factor XIa levels on admission predicted recurrent cardiovascular events (OR: 4.9 [95%CI 1.2–20.9] and 4.5 [1.1–18.9]). Conclusion ACS patients had an enhanced prothrombotic profile, demonstrated by an increased thrombin generation potential, factor XIa and D-dimer levels. This study is the first to demonstrate the positive association between factor XIa, thrombin generation and recurrent cardiovascular events.
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Affiliation(s)
- Rinske Loeffen
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- * E-mail:
| | - René van Oerle
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mathie P. G. Leers
- Departments of Clinical Chemistry & Hematology, Atrium Medical Center Parkstad, Heerlen, The Netherlands
| | - Johannes A. Kragten
- Department Of Cardiology, Atrium Medical Center Parkstad, Heerlen, The Netherlands
| | - Harry Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henri M. H. Spronk
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hugo ten Cate
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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91
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Spronk HMH, De Jong AM, Verheule S, De Boer HC, Maass AH, Lau DH, Rienstra M, van Hunnik A, Kuiper M, Lumeij S, Zeemering S, Linz D, Kamphuisen PW, Ten Cate H, Crijns HJ, Van Gelder IC, van Zonneveld AJ, Schotten U. Hypercoagulability causes atrial fibrosis and promotes atrial fibrillation. Eur Heart J 2016; 38:38-50. [PMID: 27071821 DOI: 10.1093/eurheartj/ehw119] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 12/21/2015] [Accepted: 03/02/2016] [Indexed: 01/09/2023] Open
Abstract
AIMS Atrial fibrillation (AF) produces a hypercoagulable state. Stimulation of protease-activated receptors by coagulation factors provokes pro-fibrotic, pro-hypertrophic, and pro-inflammatory responses in a variety of tissues. We studied the effects of thrombin on atrial fibroblasts and tested the hypothesis that hypercoagulability contributes to the development of a substrate for AF. METHODS AND RESULTS In isolated rat atrial fibroblasts, thrombin enhanced the phosphorylation of the pro-fibrotic signalling molecules Akt and Erk and increased the expression of transforming growth factor β1 (2.7-fold) and the pro-inflammatory factor monocyte chemoattractant protein-1 (6.1-fold). Thrombin also increased the incorporation of 3H-proline, suggesting enhanced collagen synthesis by fibroblasts (2.5-fold). All effects could be attenuated by the thrombin inhibitor dabigatran. In transgenic mice with a pro-coagulant phenotype (TMpro/pro), the inducibility of AF episodes lasting >1 s was higher (7 out of 12 vs. 1 out of 10 in wild type) and duration of AF episodes was longer compared with wild type mice (maximum episode duration 42.8 ± 68.4 vs. 0.23 ± 0.39 s). In six goats with persistent AF treated with nadroparin, targeting Factor Xa-mediated thrombin generation, the complexity of the AF substrate was less pronounced than in control animals (LA maximal activation time differences 23.3 ± 3.1 ms in control vs. 15.7 ± 2.1 ms in nadroparin, P < 0.05). In the treated animals, AF-induced α-smooth muscle actin expression was lower and endomysial fibrosis was less pronounced. CONCLUSION The hypercoagulable state during AF causes pro-fibrotic and pro-inflammatory responses in adult atrial fibroblasts. Hypercoagulability promotes the development of a substrate for AF in transgenic mice and in goats with persistent AF. In AF goats, nadroparin attenuates atrial fibrosis and the complexity of the AF substrate. Inhibition of coagulation may not only prevent strokes but also inhibit the development of a substrate for AF.
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Affiliation(s)
- Henri M H Spronk
- Department of Biochemistry, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anne Margreet De Jong
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Hetty C De Boer
- Department of Nephrology and the Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dennis H Lau
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arne van Hunnik
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Stijn Lumeij
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Stef Zeemering
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Pieter Willem Kamphuisen
- Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Harry J Crijns
- Department of Cardiology, Academic Hospital Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anton Jan van Zonneveld
- Department of Nephrology and the Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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92
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Genetic Determinants of Thrombin Generation and Their Relation to Venous Thrombosis: Results from the GAIT-2 Project. PLoS One 2016; 11:e0146922. [PMID: 26784699 PMCID: PMC4718515 DOI: 10.1371/journal.pone.0146922] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/23/2015] [Indexed: 02/07/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a common disease where known genetic risk factors explain only a small portion of the genetic variance. Then, the analysis of intermediate phenotypes, such as thrombin generation assay, can be used to identify novel genetic risk factors that contribute to VTE. Objectives To investigate the genetic basis of distinct quantitative phenotypes of thrombin generation and its relationship to the risk of VTE. Patients/Methods Lag time, thrombin peak and endogenous thrombin potential (ETP) were measured in the families of the Genetic Analysis of Idiopathic Thrombophilia 2 (GAIT-2) Project. This sample consisted of 935 individuals in 35 extended families selected through a proband with idiopathic thrombophilia. We performed also genome wide association studies (GWAS) with thrombin generation phenotypes. Results The results showed that 67% of the variation in the risk of VTE is attributable to genetic factors. The heritabilities of lag time, thrombin peak and ETP were 49%, 54% and 52%, respectively. More importantly, we demonstrated also the existence of positive genetic correlations between thrombin peak or ETP and the risk of VTE. Moreover, the major genetic determinant of thrombin generation was the F2 gene. However, other suggestive signals were observed. Conclusions The thrombin generation phenotypes are strongly genetically determined. The thrombin peak and ETP are significantly genetically correlated with the risk of VTE. In addition, F2 was identified as a major determinant of thrombin generation. We reported suggestive signals that might increase our knowledge to explain the variability of this important phenotype. Validation and functional studies are required to confirm GWAS results.
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93
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Dale BJ, Chan NC, Eikelboom JW. Laboratory measurement of the direct oral anticoagulants. Br J Haematol 2015; 172:315-36. [DOI: 10.1111/bjh.13810] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Brian J. Dale
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
| | - Noel C. Chan
- Population Health Research Institute; Hamilton Ontario Canada
| | - John W. Eikelboom
- Population Health Research Institute; Hamilton Ontario Canada
- Department of Medicine; McMaster University; Hamilton Ontario Canada
- Thrombosis and Atherosclerosis Research Institute; Hamilton Ontario Canada
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Spronk HM, Cannegieter S, Morange P, Hackeng T, Huisman M, Nagler M, Posthuma J, Ninivaggi M, Zwaveling S, van der Hulle T, Scheres LJ, van Mens TE, Mackman N. Theme 2: Epidemiology, Biomarkers, and Imaging of Venous Thromboembolism (and postthrombotic syndrome). Thromb Res 2015; 136 Suppl 1:S8-S12. [DOI: 10.1016/j.thromres.2015.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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95
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Bagot C, Leishman E. Establishing a reference range for thrombin generation using a standard plasma significantly improves assay precision. Thromb Res 2015; 136:139-43. [DOI: 10.1016/j.thromres.2015.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
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96
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Large external quality assessment survey on thrombin generation with CAT: further evidence for the usefulness of normalisation with an external reference plasma. Thromb Res 2015; 136:125-30. [DOI: 10.1016/j.thromres.2014.12.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/25/2014] [Accepted: 12/09/2014] [Indexed: 12/29/2022]
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97
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Helin TA, Lemponen M, Hjemdahl P, Rönquist-Nii Y, Lassila R, Joutsi-Korhonen L. From laboratory to clinical practice: Dabigatran effects on thrombin generation and coagulation in patient samples. Thromb Res 2015; 136:154-60. [DOI: 10.1016/j.thromres.2015.04.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 02/05/2023]
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98
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Spronk HMH, Braunschweig T, Rossaint R, Wüst DC, van Oerle R, Lauritzen B, Tolba R, Grottke O. Recombinant Factor VIIa Reduces Bleeding after Blunt Liver Injury in a Pig Model of Dilutional Coagulopathy under Severe Hypothermia. PLoS One 2015; 10:e0113979. [PMID: 26098426 PMCID: PMC4476676 DOI: 10.1371/journal.pone.0113979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022] Open
Abstract
Background Recombinant factor VIIa (rFVIIa) is registered for use in haemophilia with inhibitors and other rare bleeding disorders, but has also been used in various other clinical conditions to terminate life-threatening bleeding. Underlying conditions (e.g. coagulopathy) and dosing may affect treatment efficacy. The objective of the present study was to evaluate the impact of increasing doses of rFVIIa on blood loss and coagulation assays in haemodiluted and hypothermic pigs undergoing blunt liver injury. Methods A grade III blunt liver injury was induced in 28 pigs after 70% haemodilution and cooling to 32.6–33.4°C. Ten minutes after trauma, animals randomly received placebo or 90, 180 or 360 μg/kg rFVIIa. Global coagulation parameters, thromboelastometry (TEM) and plasma thrombin generation (TG) were determined at different time points during the observation period of 120 minutes. Results Total blood loss was significantly lower following 90 μg/kg rFVIIa (1206 [1138–1470] mL) relative to placebo (2677 [2337–3068] mL; p<0.05), with no increased effect with higher dose levels of rFVIIa. Following trauma and haemodilution, coagulation was impaired relative to baseline in both TEM and TG analysis. At 60 and 120 minutes after trauma, TEM variables improved in the rFVIIa-treated animals compared with the placebo group. Similarly, rFVIIa improved coagulation kinetics in TG. As was observed with blood loss, no significant effect between different rFVIIa dose levels was found in TEM or TG. Macro- and microscopic post-mortem examination did not reveal any signs of thromboembolic events. Conclusion Early administration of 90 μg/kg rFVIIa reduced blood loss in pigs undergoing blunt liver injury even after severe haemodilution and hypothermia, with no further effect of higher dose levels. Coagulation assays showed impaired coagulation in coagulopathic animals, with a dose-independent improvement in animals treated with rFVIIa.
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Affiliation(s)
- Henri M. H. Spronk
- Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Till Braunschweig
- Department of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Dirk C. Wüst
- Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rene van Oerle
- Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - Rene Tolba
- Institute for Laboratory Animal Science, RWTH Aachen University Hospital, Aachen, Germany
| | - Oliver Grottke
- Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany
- * E-mail:
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99
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Loeffen R, Godschalk TC, van Oerle R, Spronk HMH, Hackeng CM, ten Berg JM, ten Cate H. The hypercoagulable profile of patients with stent thrombosis. Heart 2015; 101:1126-32. [PMID: 25999588 PMCID: PMC4515992 DOI: 10.1136/heartjnl-2014-306685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/05/2015] [Indexed: 01/10/2023] Open
Abstract
Objective Coronary stent thrombosis is a devastating complication after percutaneous coronary intervention (PCI). The mechanisms underlying stent thrombosis are multifactorial. Whether the coagulation system is involved in the pathophysiology of stent thrombosis is unclear. We hypothesised that thrombin generation, reflecting the coagulation potential, is enhanced in patients with stent thrombosis. Methods A case–control study was performed, including 63 patients with PCI: 23 cases (stent thrombosis) and 40 controls (no stent thrombosis). Thrombin generation was measured using 0, 1 and 5 pM tissue factor (TF) triggers. Active site-inhibited factor VIIa (ASIS) and recombinant thrombomodulin were added to study the contact activation system and the protein C pathway, respectively. Results Thrombin generation was significantly increased for all TF triggers in cases compared with controls. Addition of ASIS to the measurement without exogenous TF revealed significantly enhanced contact activation in cases compared with controls; mean peak height: 241 vs 183 nM. Thrombin generation was also significantly increased in cases compared with controls in the presence of exogenous TF; mean peak height: 263 vs 233 nM (5 pM TF). Addition of thrombomodulin reduced thrombin generation by 23% in cases and 31% in controls (p<0.018), suggesting alterations in the protein C pathway in cases. Conclusions This is the first study that suggests the involvement of the coagulation system in stent thrombosis. Stent thrombosis patients showed a hypercoagulable state, most likely caused by enhanced contact activation and attenuation of anticoagulation by the protein C pathway.
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Affiliation(s)
- R Loeffen
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T C Godschalk
- Department of Cardiology, St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - R van Oerle
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H M H Spronk
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C M Hackeng
- Department of Clinical Chemistry, St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M ten Berg
- Department of Cardiology, St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H ten Cate
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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Activation of the factor XII-driven contact system in Alzheimer's disease patient and mouse model plasma. Proc Natl Acad Sci U S A 2015; 112:4068-73. [PMID: 25775543 DOI: 10.1073/pnas.1423764112] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Alzheimer's disease (AD) is characterized by accumulation of the β-amyloid peptide (Aβ), which likely contributes to disease via multiple mechanisms. Increasing evidence implicates inflammation in AD, the origins of which are not completely understood. We investigated whether circulating Aβ could initiate inflammation in AD via the plasma contact activation system. This proteolytic cascade is triggered by the activation of the plasma protein factor XII (FXII) and leads to kallikrein-mediated cleavage of high molecular-weight kininogen (HK) and release of proinflammatory bradykinin. Aβ has been shown to promote FXII-dependent cleavage of HK in vitro. In addition, increased cleavage of HK has been found in the cerebrospinal fluid of patients with AD. Here, we show increased activation of FXII, kallikrein activity, and HK cleavage in AD patient plasma. Increased contact system activation is also observed in AD mouse model plasma and in plasma from wild-type mice i.v. injected with Aβ42. Our results demonstrate that Aβ42-mediated contact system activation can occur in the AD circulation and suggest new pathogenic mechanisms, diagnostic tests, and therapies for AD.
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