The Routine Determination of the Endogenous Thrombin Potential, First Results in Different Forms of Hyper- and Hypocoagulability

Simone Wielders; Manjari Mukherjee; Jan Michiels; Dirk T S Rijkers; Jean-Pierre Cambus; Richard W C Knebel; Vijay Kakkar; H Coenraad Hemker; Suzette Béguin

doi:10.1055/s-0038-1656024

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1997; 77(04): 629-636
DOI: 10.1055/s-0038-1656024

Clinical Studies

Schattauer GmbH Stuttgart

The Routine Determination of the Endogenous Thrombin Potential, First Results in Different Forms of Hyper- and Hypocoagulability

Simone Wielders

¹The Department of Biochemistry, Medical Faculty and Cardiovascular Research Institute, Maastricht University, The Netherlands

,

Manjari Mukherjee

²The Thrombosis Research Institute, London, England

,

Jan Michiels

³The Clara Ziekenhuis Rotterdam, The Netherlands

,

Dirk T S Rijkers

¹The Department of Biochemistry, Medical Faculty and Cardiovascular Research Institute, Maastricht University, The Netherlands

,

Jean-Pierre Cambus

⁴The Hôpital de Ranguell, Toulouse, France

,

Richard W C Knebel

⁵The Hôpital Broussais, Laboratoire d’Hémostase, Paris, France

,

Vijay Kakkar

²The Thrombosis Research Institute, London, England

,

H Coenraad Hemker

¹The Department of Biochemistry, Medical Faculty and Cardiovascular Research Institute, Maastricht University, The Netherlands

²The Thrombosis Research Institute, London, England

,

Suzette Béguin

¹The Department of Biochemistry, Medical Faculty and Cardiovascular Research Institute, Maastricht University, The Netherlands

²The Thrombosis Research Institute, London, England

› Author Affiliations

Abstract

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Summary

The area under the thrombin generation curve (the endogenous thrombin potential; ETP) has been proposed as a parameter for plasma-based hypercoagulability and to monitor anticoagulant treatment. We present an ETP assay for the routine laboratory using a centrifugal analyser. Throughput is 30 samples/h, within and between run imprecision is 4-5.6%. Suitable substrates were developed for the ranges of 10-500% and 2-100% of normal.

Independent of tissue factor concentration (if >4 pM), the normal value of the extrinsic ETP is 384.8 ±51.7 nM.min. The intrinsic ETP, triggered by ellagic acid, is 414 ± 41 nM.min.

The ETP is decreased to 15 and 35% of normal by oral anticoagulation (INR 2.5-4.0) and by heparin administration (APTT 1.5-2.5 X control).

The ETP is increased in untreated subjects with congenital antithrombin deficiency and in women using oral contraceptives. In deep vein thrombosis (phlebographically confirmed), it is increased by 29.4% (extrinsic) and 53% (intrinsic). In (angiographically assessed) coronary artery disease the increase is by 10% and 17% respectively.

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References

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