title: Thrombin Generation Assay in Hospitalized Nonsurgical Patients: A New Tool to Assess Venous Thromboembolism Risk?
abstract: BACKGROUND
  Assessment of venous thromboembolism (VTE) risk is important to determine optimal primary prophylaxis in hospitalized patients. The Padua score helps to recognize patients with high VTE risk, but quantifying a VTE risk is often challenging in medical patients. Thrombin generation assay (TGA) reflects the pro-/anticoagulant balance and thus could help to better quantify VTE risk in medical hospitalized patients.
  
  
  OBJECTIVE
  To analyze the relation between TGA and VTE risk according to Padua score in medical hospitalized patients.
  
  
  METHODS
  Between May and October 2013, 105 patients were included in an unselected cohort group of patients admitted to an internal medicine department in a large, university hospital. Within the 36 hours after admission and before any anticoagulant therapy, Padua score was calculated and sample for TGA was collected for each patient. Thrombin generation assay (velocity, peak, and endogenous thrombin potential [ETP]) was performed with 1 and 5 picomol/l (pM) tissue factor (TF) reagent.
  
  
  RESULTS
  In patients with high Padua score (n = 29), velocity, peak, and ETP differed from patients with low Padua score. This difference was present at 1 and 5 pM TF, in ETP (P < .0001 and P = .003 respectively), in peak (P < .0001 in both conditions), and in velocity (P < .0001). According to multivariate analysis, myeloid disorders, older age, higher body mass index, myocardial infarction, C-reactive protein >5 mg/L, reduced mobility with bed rest significantly increased velocity 1 pM TF value.
  
  
  CONCLUSIONS
  Single thrombin generation measurement could help to identify patients at risk of VTE in medical hospitalized patients.
authors.affiliation: Department of Internal Medicine, University Hospital of Nantes, France olivier.espitia@chu-nantes.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Espitia
authors.affiliation: Department of Hematology, University Hospital of Nantes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Fouassier
authors.affiliation: EA4275 "Biostatistics, Pharmaco-epidemiology and Subjective Measures in Health," Nantes University, France.|Department of Methodology and Biostatistics, University Hospital of Nantes, France.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Hardouin
authors.affiliation: Department of Internal Medicine, University Hospital of Nantes, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Pistorius
authors.affiliation: Department of Internal Medicine, University Hospital of Nantes, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Agard
authors.affiliation: Department of Internal Medicine, University Hospital of Nantes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Planchon
authors.affiliation: Department of Hematology, University Hospital of Nantes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Trossaert
authors.affiliation: Department of Internal Medicine, University Hospital of Nantes, France.|EA4275 "Biostatistics, Pharmaco-epidemiology and Subjective Measures in Health," Nantes University, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001780:Blood Coagulation Tests / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy*; D055815:Young Adult
keywords: Calibrated Automated Thrombogram; Padua score; thrombin generation; venous thromboembolism risk factor