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REVIEW
Year : 2012  |  Volume : 3  |  Issue : 1  |  Page : 12-20

Is There a Reason for Testing Thrombin Generation?


Synapse BV, CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands

Correspondence Address:
Raed Al Dieri
Synapse BV, Oxfordlaan 70, 6229 EV Maastricht
the Netherlands
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Source of Support: None, Conflict of Interest: None


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Thrombin is a focal player in the coagulation system. Thrombin formation and platelet reactions occur concurrently immediately after a wound happens. Thrombin generation (TG) in platelet-rich plasma, therefore, is a close approximation of an integral function test of the hemostatic-thrombotic mechanism. In clotting blood, a transient wave of thrombin appears after a lag time. Clotting occurs at the start of the wave. The duration of the clotting time reflects the function of the initiation mechanism. The function of the production mechanism that is responsible for the burst is reflected in the area under the TG curve (endogenous thrombin potential, ETP). Clotting time and ETP therefore reflect different mechanisms and may or may not be correlated. Calibrated automated thrombinography (CAT) allows quantitative assessment of the TG curve in platelet-poor as well as platelet-rich plasma. All conditions (congenital, acquired, drug-induced) that increase TG cause a thrombotic tendency. All conditions (congenital, acquired, drug-induced) that decrease TG prevent thrombosis, but in excess, cause bleeding. Diminution of TG is a common denominator of all antithrombotic treatments, including anti-platelet drugs. Hence, the first law of hemostasis and thrombosis is "The more thrombin the less bleeding but the more thrombosis; the less thrombin the more bleeding but the less thrombosis". Procedures to measure TG in whole blood and at the point-of-care are under development.


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