Preserved clot formation detected by the Thrombodynamics analyzer in patients with cirrhosis.
BACKGROUND
Patients with cirrhosis have substantial alterations in their hemostatic system, which are paradoxically associated with the risk of both bleeding and thrombotic complications. However, it still remains difficult to predict those risks, because results from conventional coagulation tests, such as the prothrombin time (PT) and activated partial thromboplastin time (APTT), do not reflect the complex hemostatic changes in these patients. More sophisticated global hemostasis tests, such as thrombin generation assays, are not standardized for routine use yet. Here we examined the spatial clot growth in plasma from patients with cirrhosis using the novel Thrombodynamics assay, which uses a fundamentally new approach to test plasma hemostatic capacity.


METHODS
Thrombodynamics assays were performed in plasma from thirty-one patients with cirrhosis and twenty-five healthy controls. Results were compared to results with thrombin generation testing and PT/APTT test results.


RESULTS
Rates of clot growth, clot size, and clot density from the Thrombodynamics assay were comparable between patients and controls. Thrombin generation in the presence of thrombomodulin was increased in the patients, despite prolonged PT and APTT test results. There was little correlation between parameters derived from the Thrombodynamics assay and the PT, APTT, or thrombin generation data.


CONCLUSIONS
The Thrombodynamics assay showed preserved clot formation in plasma from patients with cirrhosis, which is in line with the results of the thrombin generation assay in this study and previously reported by others.
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: j.b.w.potze@umcg.nl.
Wilma
W
Potze
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jelle
J
Adelmeijer
Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Robert J
RJ
Porte
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ton
T
Lisman
D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D001780:Blood Coagulation Tests / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000209:etiology; D006487:Hemostasis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D012307:Risk Factors; D013917:Thrombin / Q000096:biosynthesis; D013927:Thrombosis / Q000097:blood / Q000209:etiology; D055815:Young Adult
D013917:Thrombin
Cirrhosis; Coagulation; Thrombin generation; Thrombodynamics; Thrombosis