Coenraad HH, Jaloma CAR

Language: Spanish
References: 34
Page: 25-31
PDF size: 120.96 Kb.

ABSTRACT

Thrombin is the “key” enzyme of the haemostatic mechanism with many functions, such as pro- and anticoagulant activities and proinflammatory effects. Thrombin generation analysis therefore is a physiological function test of the haemostatic capacity of the isolated organ blood (plasma). Unlike clotting times (PT, aPTT, WBCT) it is able to detect hyper-function, i.e. a tendency to thrombosis, which is clinically much more relevant than bleeding tendency is. The capacity of plasma to generate thrombin is reflected in the thrombin generation curve (Thrombogram) and notably in the endogenous thrombin potential (ETP), which is the area under the thrombin generation curve and is a direct measure of the amount of “enzymatic work” that thrombin can do. The currently available thrombin generation assay, Calibrated Automated Thrombogram (CAT), allows routine quantitatively correct (imprecision 2.5 – 4%) measurement of the thrombin generation curve at low cost and high throughput. Alternative devices are semi-quantitative and/or require addition of polymerisation inhibitors of fibrin that strongly influence normal thrombin generation.
Monitoring of the thrombogram allows i) to detect ongoing thrombosis; ii) to detect increased risk of thrombosis; iii) to install and monitor antithrombotic treatment; iv) to detect bleeding disorders and monitor their prophylaxis and therapy. Although arterial and venous thrombosis show important differences it seems likely that thrombin generation can cover all these indications. Especially when the test is not only carried out in platelet-poor plasma but also in platelet-rich plasma or whole blood, which is a technique that is being developed.

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