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Radin M, Barinotti A, Cecchi I, Foddai SG, Rubini E, Roccatello D, Menegatti E, Sciascia S. Thrombin generation assay and lupus anticoagulant synergically distinguish populations of patients with antiphospholipid antibodies. J Clin Pathol 2023; 76:839-846. [PMID: 36100400 DOI: 10.1136/jcp-2022-208199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
AIM To apply thrombin generation assay (TGA) in a large cohort of antiphospholipid antibodies (aPL)-positive patients. MATERIAL AND METHODS 108 patients were tested with TGA and lupus anticoagulant (LA) testing and divided according to their aPL profile. Briefly, 21 patients were positive for anti-phosphatidylserine (aPS)/prothrombin (PT) IgG/IgM (group1), 29 for anti-ß2-glycoprotein-I (aβ2GPI) and anti-cardiolipin (aCL) IgG/IgM (group2), 31 for aPS/PT, aβ2GPI and aCL IgG/IgM (group3), 27 for aPS/PT and/or aβ2GPI+aCL IgM at low-titres (group4). 31 healthy donors (HDs) and 24 controls treated with vitamin K antagonists (VKA) were included. RESULTS The most deranged TGA and LA profiles were observed in tetra-positive patients (group3) that differed significantly to the other groups, thus those with isolated, double or triple aPL-positivity. Moreover, when comparing the TGA profile of all antiphospholipid syndrome (APS) patients, aPL-carriers, HDs and VKA controls, we observed that the aPL+ patients (especially APS) showed a distinctive profile that allowed to distinguish them from the other groups with significantly higher tLag and tPeak, and lower Peak and area under the curve.When focusing on APS clinical manifestations, patients with a high-risk profile (group3) showed significant differences from those presenting low-titres aPL (group 4) regarding the number of venous events (p=0.04), recurrence of any thrombotic event (p=0.01), of arterial events (5 vs 0, p=0.02), the occurrence of TIA (p=0.04), DVT (p=0.02) and, when analysing extracriteria manifestations, of peripheral artery disease (p=0.04). CONCLUSIONS TGA seems a valuable approach to stratify aPL+ patients according to their risk profile. The differences among different populations of autoantibodies specificities could be considered a translational validation of the increased thrombotic risk of patients with triple or tetra aPL-positivity.
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Affiliation(s)
- Massimo Radin
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Alice Barinotti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Irene Cecchi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Silvia Grazietta Foddai
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Elena Rubini
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Dario Roccatello
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
| | - Elisa Menegatti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- School of Specialization of Clinical Pathology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK- net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
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Gehlen R, Vandevelde A, de Laat B, Devreese KMJ. Application of the thrombin generation assay in patients with antiphospholipid syndrome: A systematic review of the literature. Front Cardiovasc Med 2023; 10:1075121. [PMID: 37057100 PMCID: PMC10089302 DOI: 10.3389/fcvm.2023.1075121] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundThe antiphospholipid syndrome (APS) is classified by the presence of antiphospholipid antibodies (aPL) and thrombotic and/or adverse obstetric outcomes. The diagnosis and risk assessment of APS is challenging. This systematic review investigated if the thrombin generation (TG) assay could be helpful for APS diagnosis and risk assessment.MethodsA systemic review was performed by searching two databases (MEDLINE and Embase) until March 31, 2022, using a search strategy with two concepts: APS and TG, and related keywords. Two reviewers independently screened the articles based on predefined inclusion and exclusion criteria. Data extraction and quality assessment with the Newcastle-Ottawa Scale (NOS) were performed independently. Synthesis Without Meta-analysis guidelines were followed for data synthesis reporting.ResultsFourteen studies with 677 APS and 1,349 control subjects were included with variable quality according to the NOS. Twelve studies measured TG via the calibrated automated thrombogram (CAT) method using a fluorogenic substrate, whereas two used a chromogenic substrate-based TG assay. One study compared the CAT assay to the fully-automated ST Genesia® (Stago, France). Two studies initiated TG using platelet-rich plasma, whereas the rest of the studies used platelet-poor plasma. Resistance to activated protein C (aPC) was examined in ten studies. They reported a significant increase in aPC-resistance in APS patients compared to healthy controls, aPL-carriers, and thrombotic controls. Based on two studies, the prevalence of aPC-resistance was higher in APS patients compared to healthy controls and thrombotic controls with odds ratios of 5.9 and 6.8–12.8, respectively (p < 0.05). In contrast, no significant difference in aPC-resistance was found between APS patients and autoimmune disease controls. Furthermore, 7/14 studies reported TG-parameters including peak height, endogenous thrombin potential, lag time, and time to peak, but these outcomes were highly variable between studies. Furthermore, TG methodology between studies differed greatly, impacting the comparability of the studies.ConclusionaPC-resistance measured with TG was increased in APS patients compared to healthy and thrombotic controls, but the diagnostic and prognostic value is unclear compared to current diagnostic strategies. Studies of other TG-parameters were heterogeneous and more research is needed to identify their potential added value in APS diagnosis.Systematic Review Registrationhttps://www.PROSPERO/, identifier: CRD42022308363
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Affiliation(s)
- Rachel Gehlen
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arne Vandevelde
- Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Bas de Laat
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Katrien M. J. Devreese
- Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Correspondence: Katrien M. J. Devreese
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Sidonio RF, Hoffman M, Kenet G, Dargaud Y. Thrombin generation and implications for hemophilia therapies: A narrative review. Res Pract Thromb Haemost 2022; 7:100018. [PMID: 36798897 PMCID: PMC9926221 DOI: 10.1016/j.rpth.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 01/07/2023] Open
Abstract
Thrombin plays an essential role in achieving and maintaining effective hemostasis and stable clot formation. In people with hemophilia, deficiency of procoagulant factor (F)VIII or FIX results in insufficient thrombin generation, leading to reduced clot stability and various bleeding manifestations. A correlation has been found between the bleeding phenotype of people with hemophilia and the extent of thrombin generation, with individuals with increased thrombin generation being protected from bleeding and those with lower thrombin generation having increased bleeding tendency. The amount, location, and timing of thrombin generation have been found to affect the formation and stability of the resulting clot. The goal of all therapies for hemophilia is to enhance the generation of thrombin with the aim of restoring effective hemostasis and preventing or controlling bleeding; current treatment approaches rely on either replacing or mimicking the missing procoagulant (ie, FVIII or FIX) or rebalancing hemostasis through lowering natural anticoagulants, such as antithrombin. Global coagulation assays, such as the thrombin generation assay, may help guide the overall management of hemostasis by measuring and monitoring the hemostatic potential of patients and, thus, assessing the efficacy of treatment in people with hemophilia. Nevertheless, standardization of the thrombin generation assay is needed before it can be adopted in routine clinical practice.
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Affiliation(s)
- Robert F. Sidonio
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Emory University, Atlanta, Georgia, USA,Correspondence Robert F Sidonio, Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, USA. @nashgreenie
| | - Maureane Hoffman
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gili Kenet
- The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel,The Amalia Biron Thrombosis Research Institute, Tel Aviv University, Tel Aviv, Israel
| | - Yesim Dargaud
- Unité d’Hémostase Clinique, Centre National de Reference de l'Hemophilie, Hôpital Cardiologique Louis Pradel, Université Lyon, Lyon, France
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Das RK, Datta T, Biswas D, Duss R, O'Kennedy N, Duttaroy AK. Evaluation of the equivalence of different intakes of Fruitflow in affecting platelet aggregation and thrombin generation capacity in a randomized, double-blinded pilot study in male subjects. BMC Nutr 2021; 7:80. [PMID: 34865648 PMCID: PMC8647412 DOI: 10.1186/s40795-021-00485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The water-soluble tomato extract, Fruitflow® is a dietary antiplatelet which can be used to lower platelet aggregability in primary preventative settings. We carried out a pilot study to investigate the range of intakes linked to efficacy and to make an initial assessment of variability in response to Fruitflow®. METHODS Platelet response to adenosine diphosphate (ADP) agonist and thrombin generation capacity were monitored at baseline and 24 h after consuming 0, 30, 75, 150 or 300 mg of Fruitflow® in a randomized, double-blinded crossover study in male subjects 30-65 years of age (N = 12). Results were evaluated for equivalence to the standard 150 mg dose. RESULTS Results showed that the changes from baseline aggregation and thrombin generation observed after the 75 mg, 150 mg, and 300 mg supplements were equivalent. Aggregation was reduced from baseline by - 12.9 ± 17.7%, - 12.0 ± 13.9% and - 17.7 ± 15.7% respectively, while thrombin generation capacity fell by - 8.6 ± 4.1%, - 9.2 ± 3.1% and - 11.3 ± 2.3% respectively. Effects observed for 0 mg and 30 mg supplements were non-equivalent to 150 mg and not different from baseline (aggregation changed by 3.0 ± 5.0% and - 0.7 ± 10.2% respectively, while thrombin generation changed by 0.8 ± 3.0% and 0.8 ± 3.1% respectively). CONCLUSIONS The data suggest that the efficacious range for Fruitflow® lies between 75 mg and 300 mg, depending on the individual. It may be pertinent to personalize the daily intake of Fruitflow® depending on individual platelet response. TRIAL REGISTRATION ISRCTN53447583 , 24/02/2021.
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Affiliation(s)
- Ranjit K Das
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tanushree Datta
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dipankar Biswas
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ruedi Duss
- DSM Nutritional Products Ltd, 4002, Basel, Switzerland
| | - Niamh O'Kennedy
- Provexis PLC, c/o The University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK
| | - Asim K Duttaroy
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Ninivaggi M, de Laat‐Kremers RMW, Carlo A, de Laat B. ST Genesia reference values of 117 healthy donors measured with STG-BleedScreen, STG-DrugScreen and STG-ThromboScreen reagents. Res Pract Thromb Haemost 2021; 5:187-196. [PMID: 33537543 PMCID: PMC7845068 DOI: 10.1002/rth2.12455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The ST Genesia is a benchtop, fully automated thrombin generation (TG) device. It is completely standardized and ensures a uniform heat distribution throughout the measurement. We aimed to determine reference values and to compare TG in men and women with and without the use of oral contraceptives (OCs). MATERIALS AND METHODS Plasma from 117 healthy donors was measured on the ST Genesia with the available reagent kits: STG-BleedScreen, STG-DrugScreen, and STG-ThromboScreen. All kits include at least two quality controls and a reference plasma to normalize data. STG-ThromboScreen has a second trigger containing thrombomodulin (TM) to include the effect on the protein C pathway. Means were compared with one-way analysis of variance and reference ranges were established with 2.5th to 97.5th percentiles on absolute TG parameters. RESULTS Mean age of the donors was 35 years (SD ± 12); 49.6% were men, 37.6% women without OCs, and 12.8% women with OCs. Men and women without OCs had, respectively, a mean peak height of 167 nM and 164 nM with STG-BleedScreen, 335 nM and 351 nM with STG-DrugScreen, and 192 nM and 198 nM with STG-ThromboScreen. Women taking OCs had a mean peak height of 263 nM, 473 nM, and 312nM, respectively (P < .05 compared to men/women without OCs). TM decreased endogenous thrombin potential by 54% in men, 47% in women without OCs, and only 25% in women with OCs (P < .05 compared to men/women without OCs). CONCLUSIONS TG in men and women without OCs was similar; however, women taking OCs had significantly higher TG values, and the effect of TM was also less pronounced in these women.
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Affiliation(s)
| | | | | | - Bas de Laat
- Synapse Research InstituteMaastrichtThe Netherlands
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6
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Hounkpe BW, Benatti RDO, Carvalho BDS, De Paula EV. Identification of common and divergent gene expression signatures in patients with venous and arterial thrombosis using data from public repositories. PLoS One 2020; 15:e0235501. [PMID: 32780732 PMCID: PMC7418995 DOI: 10.1371/journal.pone.0235501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease (CVD) and venous thromboembolism (VTE) figure among the main causes of morbidity and mortality in modern societies. Although associated with distinct pathogenic mechanisms, epidemiological, experimental and clinical trial data suggest that the mechanisms responsible for arterial and venous thrombosis are at least partially overlapped. Herein we aimed to explore shared and discordant pathways involved in the pathogenesis of VTE and CVD at the transcriptomic level and to validate the results in independent cohorts. Five public datasets of gene expression data from VTE and CVD (myocardial infarction, peripheral arterial occlusive disease and stroke) patients were analyzed using an integrative bioinformatic strategy. A machine/statistical learning method was used to derive classifiers for the discrimination of VTE and CVD, and tested in independent datasets. Two sets of genes that were commonly (n = 472) or divergently (n = 124) expressed in CVD and VTE were identified. Genes and pathways associated with innate immune function were over-represented in both conditions, along with pathways associated with complement and hemostasis. Pathways associated with neutrophil activation and with IL-1 signaling were also enriched in CVD compared to VTE. The gene expression signature of VTE more closely resembled the pattern of cardioembolic stroke than the patterns of acute myocardial infarction, ischemic stroke and peripheral arterial occlusive disease. Classifiers derived from these gene lists accurately discriminated patients with VTE and CVD from independent cohorts. In conclusion, our results add a new set of data at the transcriptomic level for future studies between arterial and venous thrombosis.
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Affiliation(s)
| | | | - Benilton de Sá Carvalho
- Department of Statistics, Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, SP, Brazil
| | - Erich Vinicius De Paula
- School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
- Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil
- * E-mail:
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Elad B, Koren O, slim W, Turgeman Y, Avraham G, Schwartz N, Elias M. Thrombin generation's role in predicting coronary disease severity. PLoS One 2020; 15:e0237024. [PMID: 32764787 PMCID: PMC7413409 DOI: 10.1371/journal.pone.0237024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Thrombin, a key enzyme of the clotting system, is involved in thrombus formation, platelet activation, and atherosclerosis, thereby possessing a central role in the pathogenesis of ischemic heart disease. Studies have shown an association between thrombin generation (TG) and cardiovascular morbidity and mortality, but results have been equivocal. Our aim was to study the predictive ability of TG assay in evaluating coronary stenosis severity. METHODS In this prospective study we recruited patients with acute coronary syndrome (ACS) or acute chest pain (without evidence of myocardial injury) planned for coronary angiography. Thrombin generation was evaluated by Calibrated Automated Thrombogram (CAT) prior to angiography. Primary end points were significant coronary stenosis and the Syntax I score evaluated by coronary angiography. RESULTS From April 2018 through September 2019, we recruited 128 patients. In the primary analysis there was no significant association between TG and significant coronary stenosis nor between TG and syntax I score, however, there was a positive correlation between peak height and troponin peak (Spearman correlation coefficient 0.194, P-value = 0.035). In sub-group analysis, the chest pain group bare no association between TG and coronary stenosis. In unstable angina group there was an association between peak height and significant coronary stenosis (P-value = 0.029), and in non ST-elevation myocardial infarction group, TG values possessed a relatively good predictive ability of significant coronary stenosis (area under the receiver operating characteristic curve of ~65%) and a positive correlation between both lag time and ttpeak with the syntax I score was noticed (Spearman correlation coefficient 0.31, P-value = 0.099 and Spearman correlation coefficient 0.37, P-value = 0.045 respectively). CONCLUSION In patients with acute chest pain, TG values, evaluated by CAT, do not predict severity of coronary stenosis, nor do they possess prognostic value. Yet, in ACS patients, TG may have the ability to predict coronary disease severity.
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Affiliation(s)
- Boaz Elad
- Internal Medicine C, Emek Medical Center, Afula, Israel
- * E-mail:
| | - Ofir Koren
- Heart Institute, Emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Wasin slim
- Emergency Department, Emek Medical Center, Afula, Israel
| | - Yoav Turgeman
- Heart Institute, Emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gilat Avraham
- Internal Medicine C, Emek Medical Center, Afula, Israel
| | - Naama Schwartz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Mazen Elias
- Internal Medicine C, Emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Elias A, Rock W, Odetalla A, Ron G, Schwartz N, Saliba W, Elias M. Enhanced thrombin generation in patients with arterial hypertension. Thromb Res 2018; 174:121-128. [PMID: 30597342 DOI: 10.1016/j.thromres.2018.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arterial hypertension is associated with greater risk of cardiovascular diseases and thrombotic complications, suggesting that hypertension is a prothrombotic state. OBJECTIVES To investigate the relationship between arterial hypertension and thrombin generation, and between blood pressure level and thrombin generation in hypertensive patients. METHODS A total of 165 hypertensive patients and 47 healthy adults controls were include in the study. Thrombin generation was assessed in both groups by the Calibrated Automated Thrombogram (CAT) method. Ambulatory blood pressure monitoring (ABPM) was also performed for all patients in the hypertensive group. RESULTS Hypertensive patients had significantly higher levels of ETP and peak heights compared to healthy controls; means of ETP 1720.6 ± 267 and 1544.7 ± 302, respectively (P < 0.001) and means of peak height were 297.26 ± 48 and, 273 ± 53, respectively (P < 0.001). On multivariate linear regression analysis, hypertension remained independently associated with increased ETP (β = 0.185, P = 0.047). Analysis restricted to the hypertensive group with ABPM measurement showed statistically significant correlations between all measures of diastolic blood pressure (DBP) and ETP, and multivariate analysis showed that awake DBP was significantly associated with ETP (β = 0.194 for each 1-mm Hg increase in awake DBP, P = 0.012). Furthermore, hypertensive patients with cardiovascular complications had statistically elevated levels of peak height compared to hypertensive patients without cardiovascular complications. CONCLUSIONS Hypertensive patients possess enhanced thrombin generation compared healthy controls. Diastolic blood pressure level is independently correlated with increased thrombin generation in hypertensive patients. These findings suggest that arterial hypertension is a prothrombotic state.
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Affiliation(s)
- Adi Elias
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.
| | - Wasseem Rock
- Internal Medicine Department A, Emek Medical Center, Afula, Israel
| | - Ahmad Odetalla
- Department of Internal Medicine C, Emek Medical Center, Afula, Rapaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Gilat Ron
- Department of Internal Medicine C, Emek Medical Center, Afula, Rapaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
| | - Naama Schwartz
- Clinical Research Unit, Emek Medical Center, Afula, Israel; School of Public Health, University of Haifa, Israel
| | - Walid Saliba
- Translational Epidemiology Unit, Carmel Medical Center, Haifa, Rapaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
| | - Mazen Elias
- Department of Internal Medicine C, Emek Medical Center, Afula, Rapaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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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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Egan K, O’Connor H, Kevane B, Malone F, Lennon A, Zadjali A, Cooley S, Monteith C, Maguire P, Szklanna P, Allen S, McCallion N, Áinle F. Elevated plasma TFPI activity causes attenuated TF-dependent thrombin generation in early onset preeclampsia. Thromb Haemost 2017; 117:1549-1557. [DOI: 10.1160/th16-12-0949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/09/2017] [Indexed: 11/05/2022]
Abstract
SummaryEarly onset preeclampsia (EOP) is a pregnancy-specific proinflammatory disorder that is characterised by competing thrombotic and bleeding risks. It was the aim of this study to characterise thrombin generation, a major determinant of thrombotic and bleeding risk, in order to better understand the haemostatic balance in patients with EOP. Patients with EOP were recruited at the Rotunda Hospital, Dublin. Twenty-six cases of EOP were recruited over a 21-month period, out of 15,299 deliveries at the Rotunda. Blood samples were collected into sodium citrate plus corn trypsin inhibitor anticoagulated vacutainers, platelet-poor plasma was prepared, and calibrated automated thrombography was used to assess thrombin generation. Results were compared to age and sex-matched non-pregnant controls (n=13) and age-and gestation-matched pregnant controls (n=20). The rate and extent of thrombin generation triggered by low-dose tissue factor (TF) was significantly reduced in patients with EOP compared to pregnant controls, most significantly in cases of severe EOP. EOP patients displayed a trend towards an increased response to endogenous activated protein C and thrombomodulin relative to pregnant controls. Plasma tissue factor pathway inhibitor (TFPI) activity was increased in EOP patients. Inhibition of TFPI abolished the attenuation of thrombin generation stimulated by low-dose TF. In conclusion, patients with EOP are characterised by an attenuated coagulation response characterised by reduced thrombin generation stimulated by low-dose TF and elevated plasma TFPI activity. These changes in coagulation may modulate thrombotic risk and bleeding risk in patients with EOP.
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11
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Didelot M, Docq C, Wahl D, Lacolley P, Regnault V, Lagrange J. Platelet aggregation impacts thrombin generation assessed by calibrated automated thrombography. Platelets 2017; 29:156-161. [PMID: 29022492 DOI: 10.1080/09537104.2017.1356452] [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] [Indexed: 10/18/2022]
Abstract
A calibrated automated thrombogram (CAT) is performed usually with human platelet-free plasma (PFP) but may be more relevant with platelet-rich plasma (PRP). In this case, platelets are not stimulated by subendothelial molecules like collagen. Our aim was to assess the consequence of strong (collagen) or weak (ADP) induction of platelet release and aggregation on thrombin generation. Platelet aggregation in PRP was triggered with 10 µg/mL collagen or 10 µM ADP using a lumi-aggregometer. Thrombin generation curves were monitored by CAT in different conditions: PRP, PRP with activated platelets (actPRP), aggregated PRP (agPRP), aggregated platelets resuspended in autologous PFP (resPRP), PFP and PFP obtained after aggregation (agPFP). We found a 3-fold shortening of the lag time and time to peak and a marked increase in velocity and thrombin peak without changes in endogenous thrombin potential (ETP) in agPRP with both agonists compared with PRP. The same holds true in agPFP but with a marked increase in ETP compared with PFP. Similar changes in the kinetics of thrombin generation were observed with actPRP-collagen and to a lesser extent in resPRP-collagen compared with PRP. By contrast, there were no modifications of the thrombin generation curves in actPRP-ADP. Alpha-2-macroglobin-thrombin complexes were unchanged in the different PRP conditions but were increased in PFP prepared from agPFP compared to control PFP. Platelet aggregation during activation by agonists other than thrombin did not increase thrombin generation but accelerated its kinetics mainly via platelet content release and platelet-derived extracellular vesicules formation. In diseases characterized by altered platelet granule content or release as well as altered platelet activation, a platelet aggregation step prior to CAT analysis may be clinically relevant to improve laboratory estimation of the bleeding/thrombotic balance.
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Affiliation(s)
- Mélusine Didelot
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France
| | - Clémence Docq
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France
| | - Denis Wahl
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,c CHRU Nancy , Vandœuvre-lès-Nancy , France
| | - Patrick Lacolley
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,c CHRU Nancy , Vandœuvre-lès-Nancy , France
| | - Véronique Regnault
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,c CHRU Nancy , Vandœuvre-lès-Nancy , France
| | - Jérémy Lagrange
- a INSERM, U1116 , Faculté de Médecine , Vandoeuvre-les-Nancy , France.,b Université de Lorraine , Nancy , France.,d Center for Thrombosis and Hemostasis , University Medical Center Mainz , Mainz , Germany
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12
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Hoffman M, Monroe DM. Impact of Non-Vitamin K Antagonist Oral Anticoagulants From a Basic Science Perspective. Arterioscler Thromb Vasc Biol 2017; 37:1812-1818. [PMID: 28798139 DOI: 10.1161/atvbaha.117.306995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/21/2017] [Indexed: 12/21/2022]
Abstract
The biochemical properties of the non-vitamin K antagonist oral anticoagulants (NOACs) and their differences from the mechanism of action of vitamin K antagonists contribute to their properties as anticoagulants. These properties include as follows: (1) Inhibiting a single protease is much less effective at inhibiting coagulation than is inhibiting at multiple steps. Thus, the dose-response relationship between NOAC level and intensity of anticoagulation is shallower and more linear than that of vitamin K antagonists. This partially accounts for the greater safety of NOACs than vitamin K antagonists reported in some studies. (2) Because they are small molecules, NOACs can reach their target proteases in locations that plasma protease inhibitors, such as antithrombin, cannot. (3) NOACs compete with substrates for binding at the active site of the target protease and that binding is reversible. When the drug level falls, the drug dissociates from its target, and protease activity is restored. Thus, there is the possibility of a rebound in procoagulant activity if the drug is abruptly terminated. (4) The effects of a NOAC can be overcome by increasing the amount of substrate available for the target protease or the amount of protease produced. This property may contribute to the safety of NOACs and their potential reversibility by coagulation factor concentrates. The biochemical properties of NOACs contribute to their suitability for use in conditions that require a predictable moderate degree of anticoagulation when administered orally at a consistent dose. Their effects can be overcome by a sufficiently strong procoagulant stimulus. This characteristic likely contributes to their generally reduced risk of serious bleeding. However, they are not well suited for use in settings that require a profound degree of anticoagulation.
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Affiliation(s)
- Maureane Hoffman
- From the Pathology and Laboratory Medicine Service, Durham Veterans Affairs Medical Center, NC (M.H.); Department of Pathology, Duke University Medical Center, Durham, NC (M.H.); McAlister Heart Institute, Chapel Hill, NC (M.H., D.M.M.); and Department of Medicine, the University of North Carolina, Chapel Hill (M.H., D.M.M.).
| | - Dougald M Monroe
- From the Pathology and Laboratory Medicine Service, Durham Veterans Affairs Medical Center, NC (M.H.); Department of Pathology, Duke University Medical Center, Durham, NC (M.H.); McAlister Heart Institute, Chapel Hill, NC (M.H., D.M.M.); and Department of Medicine, the University of North Carolina, Chapel Hill (M.H., D.M.M.)
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13
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Sassi M, Chakroun T, Chouchène S, Hellara I, Boubaker H, Grissa MH, Khochtali I, Hassine M, Addad F, Elalamy I, Nouira S. Does Lipid Profile Affect Thrombin Generation During Ramadan Fasting in Patients With Cardiovascular Risks? Clin Appl Thromb Hemost 2016; 23:980-986. [PMID: 27613563 DOI: 10.1177/1076029616665920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is evidence that diet and variation in lipid metabolism can influence blood coagulation, but little is known about the effect of Ramadan fasting on plasmatic coagulation pattern. We investigated the effect of Ramadan fasting on thrombin generation (TG) in patients with cardiovascular disease (CVD) risks, and we aimed to assess the effect of lipid profile on TG parameters. The study was conducted in 36 adults having at least 2 CVD risks and in 30 healthy controls. Coagulation pattern was assessed by both classical clotting times and TG test. A complete lipid profile was performed simultaneously. Patients were invited 2 times: 1 week before Ramadan and during the last week of the Ramadan. The TG parameters were not different in patients with CVD risks compared to healthy controls. Fasting had no effect on plasmatic coagulation parameters and on TG profile. Individual analysis of the mean rate index (MRI) of TG revealed 3 groups: group 1 with no modification of MRI, group 2 with a significant increase in MRI (81.64 nM/min vs 136.07 nM/min; P < .001), and group 3 with a significant decrease in MRI (125.27 nM/min vs 73.18 nM/min; P = .001). Only in group 2, a significant increase was observed in total cholesterol and low-density lipoprotein cholesterol. Changes in lipid profile during Ramadan fasting did not influence the global coagulation pattern in patients with CVD risks. Whereas, a significant increase in the propagation phase of TG was associated with a significant increase in cholesterol levels, which was not found with the other TG parameters.
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Affiliation(s)
- Mouna Sassi
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.,2 Laboratory of Hematology, University Hospital Tenon, ER2 UPMC, Paris, France
| | - Taher Chakroun
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Saoussen Chouchène
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Ilhem Hellara
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Ines Khochtali
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Mohsen Hassine
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Faouzi Addad
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
| | - Ismail Elalamy
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia.,2 Laboratory of Hematology, University Hospital Tenon, ER2 UPMC, Paris, France
| | - Semir Nouira
- 1 Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital and University of Monastir, Monastir, Tunisia
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14
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Zavyalova E, Kopylov A. Exploring potential anticoagulant drug formulations using thrombin generation test. Biochem Biophys Rep 2016; 5:111-119. [PMID: 28955812 PMCID: PMC5600416 DOI: 10.1016/j.bbrep.2015.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 01/20/2023] Open
Abstract
Many anticoagulant drugs inhibiting proteins of the coagulation cascade have been developed. The main targets of anticoagulant drugs are thrombin and factor Xa; inhibiting these factors delays thrombus growth, thus preventing thrombosis while increasing bleeding risk. A balance between thrombosis and bleeding is ensured in the ‘therapeutic window’ of the anticoagulant drug concentration range. Novel anticoagulant drugs and combinations thereof are being developed. We rank coagulation factors as potential anticoagulant drug targets in combination with thrombin inhibitors, aptamer HD1 and bivalirudin, providing a background for several promising dual target treatment strategies. The thrombin generation test was used to assess the whole coagulation cascade in normal and factor-deficient human blood plasma. Potential therapeutic windows were estimated for coagulation factors, ranking them as targets for anticoagulant drugs. Thrombin and factor Xa have been revealed as the most promising targets, which fully agrees with the current drug development strategy. Inhibitors of factors Va and VIIa are expected to have narrow therapeutic windows. Inhibitors of factors VIIIa and IXa are expected to have a moderate anticoagulant effect. Factors XI and XII are poor targets for anticoagulant drugs. Compared with plasma that is deficient in factor II, the thrombin inhibitors bivalirudin and aptamer HD1 had increased activity. Both inhibitors were tested in deficient plasma providing a model of potential drug combination. The most promising combinations were anti-thrombin with anti-V/Va and also anti-thrombin with anti-IX/IXa. Each combination had an incremental dose-effect dependence that is promising from the standpoint of the therapeutic window. Coagulation factors are ranked as anticoagulant targets. Several promising combinations of anticoagulant and thrombin inhibitor are proposed. The most promising combinations are anti-thrombin with anti-V/Va or anti-IX/IXa.
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Affiliation(s)
- Elena Zavyalova
- Chemistry Department of Lomonosov Moscow State University, 'Apto-Pharm' LTD, Moscow, Russian Federation
| | - Alexey Kopylov
- Chemistry Department of Lomonosov Moscow State University, 'Apto-Pharm' LTD, Moscow, Russian Federation
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15
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Baeriswyl V, Calzavarini S, Chen S, Zorzi A, Bologna L, Angelillo-Scherrer A, Heinis C. A Synthetic Factor XIIa Inhibitor Blocks Selectively Intrinsic Coagulation Initiation. ACS Chem Biol 2015; 10:1861-70. [PMID: 25989088 DOI: 10.1021/acschembio.5b00103] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Coagulation factor XII (FXII) inhibitors are of interest for the study of the protease in the intrinsic coagulation pathway, for the suppression of contact activation in blood coagulation assays, and they have potential application in antithrombotic therapy. However, synthetic FXII inhibitors developed to date have weak binding affinity and/or poor selectivity. Herein, we developed a peptide macrocycle that inhibits activated FXII (FXIIa) with an inhibitory constant Ki of 22 nM and a selectivity of >2000-fold over other proteases. Sequence and structure analysis revealed that one of the two macrocyclic rings of the in vitro evolved peptide mimics the combining loop of corn trypsin inhibitor, a natural protein-based inhibitor of FXIIa. The synthetic inhibitor blocked intrinsic coagulation initiation without affecting extrinsic coagulation. Furthermore, the peptide macrocycle efficiently suppressed plasma coagulation triggered by contact of blood with sample tubes and allowed specific investigation of tissue factor initiated coagulation.
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Affiliation(s)
- Vanessa Baeriswyl
- Institute
of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Sara Calzavarini
- University
Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital and the University of Bern, Inselspital, CH-3010 Bern, Switzerland
- Department
of Clinical Research, University of Bern, CH-3010 Bern, Switzerland
| | - Shiyu Chen
- Institute
of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Alessandro Zorzi
- Institute
of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Luca Bologna
- University
Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital and the University of Bern, Inselspital, CH-3010 Bern, Switzerland
- Department
of Clinical Research, University of Bern, CH-3010 Bern, Switzerland
| | - Anne Angelillo-Scherrer
- University
Clinic of Hematology and Central Hematology Laboratory, Bern University Hospital and the University of Bern, Inselspital, CH-3010 Bern, Switzerland
- Department
of Clinical Research, University of Bern, CH-3010 Bern, Switzerland
| | - Christian Heinis
- Institute
of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
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16
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Lancé MD. A general review of major global coagulation assays: thrombelastography, thrombin generation test and clot waveform analysis. Thromb J 2015; 13:1. [PMID: 25937820 PMCID: PMC4417204 DOI: 10.1186/1477-9560-13-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/16/2014] [Indexed: 01/08/2023] Open
Abstract
Thrombosis and hemorrhage are major contributors to morbidity and mortality. The traditional laboratory tests do not supply enough information to diagnose and treat patients timely and according to their phenotype. Global hemostasis tests might improve this circumstance. The viscoelastic tests (ROTEM/TEG) demonstrated to ameliorate treatment of acute hemorrhage in terms of decreased amount of transfusion and lowered costs. Thrombin generation measurement is indicative for thrombosis and might also become an important tool in managing hemorrhage. While the clot waveform analysis is less well known it could be of worth in staging sepsis patients, early detection of DIC and also in diagnosis and treatment monitoring of hemophiliac patients. Although in different degree all three methods still need more background, standardization and acceptance before a wide clinical application.
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Affiliation(s)
- Marcus D Lancé
- Department of Anesthesiology and Pain Treatment, Maastricht University Medical Center, P. Debyelaan 25, PO box 5800, 6202 AZ Maastricht, The Netherlands
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17
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Li YJ, Chiu WJ, Unnikrishnan B, Huang CC. Monitoring thrombin generation and screening anticoagulants through pulse laser-induced fragmentation of biofunctional nanogold on cellulose membranes. ACS APPLIED MATERIALS & INTERFACES 2014; 6:15253-15261. [PMID: 25141032 DOI: 10.1021/am503615c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Thrombin generation (TG) has an important part in the blood coagulation system, and monitoring TG is useful for diagnosing various health issues related to hypo-coagulability and hyper-coagulability. In this study, we constructed probes by using mixed cellulose ester membranes (MCEMs) modified with gold nanoparticles (Au NPs) for monitoring thrombin activity using laser desorption/ionization mass spectrometry (LDI-MS). The LDI process produced Au cationic clusters ([Au(n)](+); n = 1-3) that we detected through MS. When thrombin reacted with fibrinogen on the Au NPs-MCEMs, insoluble fibrin was formed, hindering the formation of Au cationic clusters and, thereby, decreasing the intensity of their signals in the mass spectrum. Accordingly, we incorporated fibrinogen onto the Au NPs-MCEMs to form Fib-Au NPs-MCEM probes to monitor TG with good selectivity (>1000-fold toward thrombin with respect to other proteins or enzymes) and sensitivity (limit of detection for thrombin of ca. 2.5 pM in human plasma samples). Our probe exhibited remarkable performance in monitoring the inhibition of thrombin activity by direct thrombin inhibitors. Analyses of real samples using our new membrane-based probe suggested that it will be highly useful in practical applications for the effective management of hemostatic complications.
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Affiliation(s)
- Yu-Jia Li
- Institute of Bioscience and Biotechnology, National Taiwan Ocean University , Keelung 20224, Taiwan
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18
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Global Thrombosis Test (GTT) can detect major determinants of haemostasis including platelet reactivity, endogenous fibrinolytic and thrombin generating potential. Thromb Res 2014; 133:919-26. [PMID: 24613697 DOI: 10.1016/j.thromres.2014.02.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/09/2013] [Accepted: 02/19/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Detection of both thrombosis and bleeding risk are essential in clinical cardiology. Thrombin generated by activated platelets and from the extrinsic coagulation pathway is the major determinant of thrombogenesis and hemostasis. Although novel oral anticoagulants further increase the bleeding risk of antiplatelet drugs, platelet function tests do not reliably predict hemorrhagic complications. It seems that in addition to platelet aggregation, true assessment of bleeding risks requires the measurement of both platelet and plasma derived thrombin activity. OBJECTIVE To adapt a novel, near-patient test for the assessment of both antithrombotic and anticoagulant effects of oral thrombin inhibitors. METHODS The point-of-care Global Thrombosis Test (GTT), which measures platelet reactivity to shear-activation in native blood, was used. Thrombin, generated from activated platelets (procoagulant activity) plays a pivotal role in GTT measurement. In order to assess endogenous thrombin potential, in a separate blood sample thrombin generation was induced by microparticles formed during hypotonic hemolysis. Thus two blood samples were tested to measure simultaneously platelet reactivity (occlusion time, OT) and hemolysis (microparticles)-induced endogenous thrombin potential (OT-H). RESULTS In healthy subjects (n=32), OT measured in native blood was reduced in hemolysed blood (100% vs. 43 ± 4%; OT vs. OT-H respectively). Shortening of OT in hemolysed blood (OT-H) was dose-dependently inhibited by the in vitro added thrombin inhibitor argatroban. In patients receiving dabigatran (n=27), OT and, to a lesser extent, OT-H was prolonged, compared to healthy volunteers. Intra-assay variation of OT-H was low (4.5%), but interindividual variation was great, both in healthy subjects (61%) and in patients on dabigatran (65%). Thrombin inhibitors argatroban, heparin (in vitro) and dabigatran (in vivo) all prolonged both OT and OT-H. There was no correlation between the measured OT and OT-H data. CONCLUSIONS Microparticles shed from erythrocytes during hypotonic lysis of native blood considerably shortened OT. In a direct proportion to the applied concentrations, various thrombin inhibitors prolonged both OT (antithrombotic effect) and to a lesser extent, OT-H (anticoagulant effect). Further large studies are required to evaluate the usefulness of this technique in a clinical setting, in assessing the anticoagulant and antithrombotic effects of medication and relating GTT results with observed thrombotic and bleeding events.
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Campo G, Pavasini R, Pollina A, Tebaldi M, Ferrari R. Coagulation Factors and Recurrence of Ischemic and Bleeding Adverse Events in Patients with Acute Coronary Syndromes. Thromb Res 2013; 132:151-7. [DOI: 10.1016/j.thromres.2013.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/25/2013] [Accepted: 06/06/2013] [Indexed: 02/08/2023]
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Wong PC, White A, Luettgen J. Inhibitory effect of apixaban compared with rivaroxaban and dabigatran on thrombin generation assay. Hosp Pract (1995) 2013; 41:19-25. [PMID: 23466964 DOI: 10.3810/hp.2013.02.1009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effect of the oral direct activated factor X (factor Xa) inhibitor apixaban on tissue factor-induced thrombin generation in human plasma was investigated in vitro using the calibrated automated thrombogram (CAT) method and compared with the oral direct factor Xa inhibitor rivaroxaban and the direct thrombin inhibitor dabigatran. Pooled citrated, anticoagulated, platelet-poor human plasma was spiked with apixaban, rivaroxaban, or dabigatran at concentrations of 0.01 to 10 μM. The inhibitory potencies of the compounds were quantified by 5 CAT parameters: the control thrombin lag time (LT) and time to thrombin peak (TTP) for the doubling of inhibitor concentration (IC2x); and the control endogenous thrombin potential (ETP), thrombin peak, and maximum rate of thrombin generation (Vmax) for the inhibitor concentration, which inhibited 50% (IC50). The inhibitors modified CAT concentration dependently. Their inhibitory potencies, expressed as IC2x LT, IC2x TTP, IC50 ETP, IC50 peak thrombin, and IC50 Vmax, were as follows: 0.10 ± 0.01, 0.19 ± 0.02, 0.65 ± 0.11, 0.089 ± 0.019, and 0.049 ± 0.007 μM for apixaban; 0.049 ± 0.007, 0.070 ± 0.009, 0.43 ± 0.07, 0.048 ± 0.008, and 0.022 ± 0.005 μM for rivaroxaban; and 0.063 ± 0.019, 0.18 ± 0.06, 0.50 ± 0.08, 0.55 ± 0.06, and 0.57 ± 0.27 μM for dabigatran. In summary, apixaban, rivaroxaban, and dabigatran have similar potencies in the prolongation of LT and TTP. The CAT parameters that are related to the rate of thrombin generation during the propagation phase (ie, peak thrombin and Vmax) are more sensitive to activities of apixaban and rivaroxaban than dabigatran. The ETP is the least sensitive parameter for measuring the activities of these inhibitors. Recombinant activated factor VII at 5 and 50 μg/mL reversed the anticoagulant effects of apixaban more at 0.2 μM than at 2 μM. Our study suggests that the CAT method is a sensitive assay to monitor the pharmacodynamic and pharmacokinetic properties of apixaban, rivaroxaban, and dabigatran, and may provide insight into the mechanism of action of these inhibitors. Recombinant activated factor VII may have some potential to reverse the anticoagulant effects of apixaban in vitro.
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