The routine determination of the endogenous thrombin potential, first results in different forms of hyper- and hypocoagulability.
The area under the thrombin generation curve (the endogenous thrombin potential; ETP) has been proposed as a parameter for plasma-based hypercoagulability and to monitor anticoagulant treatment. We present an ETP assay for the routine laboratory using a centrifugal analyser. Throughput is 30 samples/h, within and between run imprecision is 4-5.6%. Suitable substrates were developed for the ranges of 10-500% and 2-100% of normal. Independent of tissue factor concentration (if > 4 pM), the normal value of the extrinsic ETP is 384.8 +/- 51.7 nM.min. The intrinsic ETP, triggered by ellagic acid, is 414 +/- 41 nM.min. The ETP is decreased to 15 and 35% of normal by oral anticoagulation (INR 2.5-4.0) and by heparin administration (APTT 1.5-2.5 x control). The ETP is increased in untreated subjects with congenital antithrombin deficiency and in women using oral contraceptives. In deep vein thrombosis (phlebographically confirmed), it is increased by 29.4% (extrinsic) and 53% (intrinsic). In (angiographically assessed) coronary artery disease the increase is by 10% and 17% respectively.
Wielders
S
S
Department of Biochemistry, Medical Faculty and Cardiovascular Research Institute, Maastricht University, The Netherlands.
Mukherjee
M
M
Michiels
J
J
Rijkers
D T
DT
Cambus
J P
JP
Knebel
R W
RW
Kakkar
V
V
Hemker
H C
HC
Béguin
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D019540:Area Under Curve; D001778:Blood Coagulation Disorders / Q000097:blood*; D003955:Diagnostic Tests, Routine; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D013917:Thrombin / Q000096:biosynthesis*; D013925:Thromboplastin / Q000378:metabolism; D013927:Thrombosis / Q000188:drug therapy*
D000925:Anticoagulants; D013925:Thromboplastin; D013917:Thrombin