Thrombin generation and rotational thromboelastometry in the healthy adult population

Summary

Aim

Published data on thrombin generation variables and their correlation with thrombo - elastometry in the healthy population are scarce. This study aimed at assessing thrombin generation in adults and its correlation to classical rotational thromboelastometry (ROTEM).

Methods

Thrombin generation was measured in platelet-poor plasma from healthy volunteers using the calibrated automated thrombogram (CAT) with 1 and 5 pmol/l tissue factor final concentration. Lag time, thrombin peak, time to thrombin peak and endogenous thrombin potential (ETP) were analyzed. ROTEM was performed without activator (NATEM) and data for clotting time, alpha angle, clot formation time and maximum clot firmness were correlated with those of thrombin generation.

Results

Altogether 132 persons (72 men, 60 women; median age: 48.0 years) were included. There was a positive non-linear correlation for age versus lag time (p < 0.001) and time to peak (p = 0.001), and almost linear correlation for age versus thrombin peak (p = 0.024) and ETP (p = 0.001), although with a moderate regression slope. Regarding ROTEM, there was a positive correlation between age and maximum clot firmness and alpha angle (p = 0.001), but a negative correlation between age and clotting time (p = 0.039). Comparing both assays, thrombin peak and ETP measured with a final tissue factor concentration of 5 pmol/l correlated significantly with alpha angle and maximum clot firmness.

Conclusion

The age-related changes in CAT and ROTEM variables among adults are not linear. There is a significant correlation, although with a moderate slope, between data from CAT measured with 5 pmol/l tissue factor and ROTEM.

Zusammenfassung

Es gibt nur wenige Studien zur Korrelation zwischen den Parametern Thrombingenerierung und Thromboelastometrie an Gesunden. Ziel der Studie ist die Thrombingenerierung an gesunden Erwachsenen zu untersuchen und die Daten mit denen der klassischen Rotationsthromboelastometrie (ROTEM) zu vergleichen.

Methoden

Thrombingenerierung wurde in plättchenarmem Plasma mittels Calibrated Automated Thrombogram (CAT) mit 1 und 5 pmol/l Gewebefaktor-Endkonzentration analysiert. Die Parameter Lag-time, Thrombin-Peak, Time-to-thrombin-Peak und endogenes Thrombinpotenzial (ETP) wurden ausgewertet. ROTEM wurde ohne Aktivator (NATEM) durchgeführt und die Daten für Gerinnungszeit, Alpha-Winkel, Gerinnselbildungszeit und maximale Gerinnselfestigkeit dokumentiert und mit denen der CAT korreliert.

Ergebnisse

Insgesamt nahmen 132 Personen (72 Männer, 60 Frauen; medianes Alter: 48,0 Jahre) teil. Eine signifikante positive nicht-lineare Korrelation für Alter versus Lag-time (p < 0,001) und Time-to-peak (p = 0,001) und nahezu lineare Korrelation für Alter versus Thrombin-Peak (p = 0,024) und ETP (p = 0,001) wurde beobachtet, allerdings mit moderater Regressionssteigung. Im Bezug auf ROTEM gab es eine positive Korrelation zwischen Alter und maximaler Gerinnselfestigkeit und Alpha-Winkel (p = 0,001), jedoch eine negative Korrelation zwischen Alter und Gerinnungszeit (p = 0,039). Thrombin- Peak und ETP, gemessen mit 5 pmol/l Gewebefaktorkonzentration, zeigten eine signifikante Korrelation gegenüber maximaler Gerinnselfestigkeit und Alpha-Winkel, allerdings mit moderater Regressionssteigung.

Schlussfolgerung

Altersabhängige Änderungen der CAT- und ROTEM-Parameter bei Erwachsenen sind nicht linear. Die Korrelation zwischen CAT und ROTEM ist je nach Gewebefaktorkonzentration im Testansatz unterschiedlich.

Keywords

Thrombin generation - calibrated automated thrombogram - rotational thromboelastometry

Schlüsselwörter

Thrombingenerierung - Calibrated Automated Thrombogram - Rotationsthromboelasto metrie

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