title: Use of calibrated automated thrombinography +/- thrombomodulin to recognise the prothrombotic phenotype.
abstract: There is currently no validated method to detect a prothrombotic phenotype. The question remains, can tissue factor (TF) induced thrombin generation (TG), as measured with the calibrated automated thrombinography (CAT) technique, according to Hemker et al., recognise a prothrombotic state either as such, or when the activated protein C (APC)-system is boosted with thrombomodulin (TM)? We determined the normal range of CAT-TG +/- TM in a group of 71 healthy blood donors, in 11 healthy women using oral contraceptives (OC), and in 89 patients with a history of venous thromboembolism (VTE), divided into a group of 50 in which a prothrombotic risk factor could be found (VTEprf+) and 39 others (VTEprf-). The endogenous thrombin potential (ETP) in the OC, VTEprf+ and VTEprf- group was significantly higher than for the controls. In the presence of TM, the differences were significantly higher than in its absence. The VTEprf+ group had a higher ETP, +/- TM than the VTEprf-group. In conclusion, TG, measured with the CAT technique in the presence of TM is capable of detecting the prothrombotic phenotype with a high sensitivity of 0.93 (95% confidence limits 0.82-0.99).
authors.affiliation: Unite d'Hemostase Clinique- Laboratoire d'Hemostase, Hopital Edouard Herriot, Lyon, France. ydargaud@univ-lyon1.fr
authors.forename: Yesim
authors.initials: Y
authors.lastname: Dargaud
authors.forename: M Christine
authors.initials: MC
authors.lastname: Trzeciak
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Bordet
authors.forename: Jacques
authors.initials: J
authors.lastname: Ninet
authors.forename: Claude
authors.initials: C
authors.lastname: Negrier
mesh_terms: D000328:Adult; D000368:Aged; D001331:Automation; D001780:Blood Coagulation Tests / Q000295:instrumentation / Q000379:methods / Q000592:standards; D002138:Calibration; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013917:Thrombin / Q000032:analysis* / Q000096:biosynthesis; D018180:Thrombomodulin; D019851:Thrombophilia / Q000175:diagnosis*; D013925:Thromboplastin / Q000502:physiology; D020246:Venous Thrombosis
chemical_list: D018180:Thrombomodulin; D013925:Thromboplastin; D013917:Thrombin