title: Protein Z efficiently depletes thrombin generation in disseminated intravascular coagulation with poor prognosis.
abstract: Disseminated intravascular coagulation (DIC) is characterized by consumption of coagulation factors and anticoagulants. Thrombin generation assay (TGA) gives useful information about global hemostatic status. We developed a new TGA system that anticoagulant addition can deplete thrombin generation in plasma, which may reflect defective anticoagulant system in DIC. TGAs were measured on the calibrated automated thrombogram with and without thrombomodulin or protein Z in 152 patients who were suspected of having DIC, yielding four parameters including lag time, endogenous thrombin potential, peak thrombin and time-to-peak in each experiment. Nonsurvivors showed significantly prolonged lag time and time-to-peak in TGA-protein Z system, which was performed with added protein Z. In multivariate Cox regression analysis, lag time and time-to-peak in TGA system were significant independent prognostic factors. In TGA-protein Z system, lag time and time-to-peak were revealed as independent prognostic factors of DIC. Protein Z addition could potentiate its anticoagulant effect in DIC with poor prognosis, suggesting the presence of defective protein Z system. The prolonged lag time and time-to-peak in both TGA and TGA-protein Z systems are expected to be used as independent prognostic factors of DIC.
authors.affiliation: aDepartment of Laboratory Medicine bCancer Research Institute cDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Nuri
authors.initials: N
authors.lastname: Lee
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Ja-Yoon
authors.initials: JY
authors.lastname: Gu
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Yoo
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.forename: Kyou-Sup
authors.initials: KS
authors.lastname: Han
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000368:Aged; D001798:Blood Proteins / Q000378:metabolism*; D004211:Disseminated Intravascular Coagulation / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013917:Thrombin / Q000378:metabolism*
chemical_list: D001798:Blood Proteins; C026080:plasma protein Z; D013917:Thrombin