A general review of major global coagulation assays: thrombelastography, thrombin generation test and clot waveform analysis.

Marcus D Lancé

doi:10.1186/1477-9560-13-1

Abstract

Thrombosis and hemorrhage are major contributors to morbidity and mortality. The traditional laboratory tests do not supply enough information to diagnose and treat patients timely and according to their phenotype. Global hemostasis tests might improve this circumstance. The viscoelastic tests (ROTEM/TEG) demonstrated to ameliorate treatment of acute hemorrhage in terms of decreased amount of transfusion and lowered costs. Thrombin generation measurement is indicative for thrombosis and might also become an important tool in managing hemorrhage. While the clot waveform analysis is less well known it could be of worth in staging sepsis patients, early detection of DIC and also in diagnosis and treatment monitoring of hemophiliac patients. Although in different degree all three methods still need more background, standardization and acceptance before a wide clinical application.

Highlights

Thrombosis and hemorrhage contribute to a large amount of death in terms of ischemic heart disease, stroke and traumatic injuries [1]
The tests have been standardized for monitoring therapy
The present review describes the viscoelastic tests (TEG/ROTEM), thrombin generation test (TGT) and the clot waveform analysis (CWA) as global clotting test giving some background information, clinical applications and information on their limits

Summary

Introduction

Thrombosis and hemorrhage contribute to a large amount of death in terms of ischemic heart disease, stroke and traumatic injuries [1]. They are recommend for management of acute (acquired) hemorrhage these tests need some laboratory turnaround time and may not reflect the complexity of the hemostatic impairment In this light the traditional coagulation tests (aPTT and PT/INR) are scrutinized for this clinical applicability. The authors could identify hemophiliac patients the test was very work and time intensive, because the measurement had to be done by continuously subsampling To overcome this problem many years later Hemker and Beguin developed a method using a chromogenic substrate. The assay gives information on the clinical phenotype with regard of bleeding tendency Doing so it might help monitoring treatment of these patients with factor concentrates and with bypassing agents [52]. Due to the fact that there is not much experience with this assay the parameters seem quite unknown and there is not much literature with regard to clinical validation

Conclusions

Findings

52. Shima M