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DOI: 10.1055/s-0030-1265284
© Thieme Medical Publishers
Global Hemostasis: New Approaches to Patient Diagnosis and Treatment Monitoring
Publication History
Publication Date:
26 October 2010 (online)
Welcome to another issue of Seminars in Thrombosis and Hemostasis. In this issue, Maha Othman has put together an interesting collection of articles that reviews the topic of global hemostasis. The concept of global hemostasis is certainly not new. As the name implies, global hemostasis assays are intended to assess the risk of bleeding, thrombosis, fibrinolysis, and response to antithrombotics in various clinical conditions using a single assay, typically performed on whole blood.
One of the methodologies used for global hemostasis highlighted in the current issue is thromboelastography (TEG), which has a long history (as briefly reviewed here by Wegner and Popovsky[1] and by Othman et al[2]). It was first described in 1948, >60 years ago. The methodology was introduced as a tool for the management of acute bleeding in liver transplantation and cardiac surgery in the 1980s. Other uses for TEG were explored between the 1980s and early 1990s, and the mid to late 1990s saw an intensive use in trauma and in obstetrics, monitoring coagulopathy in preeclampsia and other pregnancy complications.[2] Nevertheless, most studies exploring the benefit of TEG measurements compared with standard coagulation tests were in anesthesia and trauma patients. Today, the technology is finding additional utility in a broad range of applications, as highlighted by several articles in this issue.
Like many early tests of hemostasis, a more broad-based acceptance of TEG from its early beginnings required improved methodologies and user-friendly instrumentation. Today, two instrument driven methodologies that appear to dominate for clinical use are the TEG (Thromboelastograph; Haemoscope Corp., Niles, IL, USA) and the ROTEM (Rotation Thromboelastometer; Pentapharm GmbH, Munich, Germany). Because the ROTEM is not approved by the Food and Drug Administration for use in the United States, the relative utility of TEG versus ROTEM may be geographically based. However, a broader acceptance of this methodology requires better standardization and evidence of broader comparability, as highlighted in this issue by Chitlur and Lusher[3] and Kitchen et al.[4] Seminars in Thrombosis and Hemostasis last featured TEG in a supplement in 1995.[5] Thus the inclusion of TEG within a current issue is certainly timely.
Other tests and concepts of global hemostasis are also explored, including the overall hemostasis potential (OHP) and thrombin generation.[6] [7] [8] The concept and topic of thrombin generation has been selectively explored within several previous issues of Seminars in Thrombosis and Hemostasis over the past decade.[9] [10] [11] [12] [13] [14]
I would like to thank Maha Othman for putting together this interesting update of global hemostasis, and I hope that our readers enjoy its many treasures. Professor Othman has recently joined us an associate editor. She last guest edited an issue of Seminars in Thrombosis and Hemostasis in 2008 on molecular genetic testing in hemostasis and thrombosis.[15]
REFERENCES
- 1 Wegner J, Popovsky M A. Clinical utility of thromboelastography: one size does not fit all. Semin Thromb Hemost. 2010; 36(7) 699-706
- 2 Othman M, Falcon B, Kadir R. Global hemostasis in pregnancy: are we utilizing thromboelastography to its full potential?. Semin Thromb Hemost. 2010; 36(7) 738-746
- 3 Chitlur M, Lusher J. Standardization of thromboelastography: values and challenges. Semin Thromb Hemost. 2010; 36(7) 707-711
- 4 Kitchen D P, Kitchen S, Jennings I, Woods T, Walker I. Quality assurance and quality control of thrombelastography and rotational thromboelastometry: the UK NEQAS for Blood Coagulation experience. Semin Thromb Hemost. 2010; 36(7) 757-763
- 5 Caprini J A, Traverso C I, Walenga J M, Arcelus J I, Fareed J, Spiess B D. Guest Editors. Thromboelastrography. Semin Thromb Hemost. 1995; 21(Suppl 4) 1-93
- 6 Antovic A. The overall hemostasis potential: a laboratory tool for the investigation of global hemostasis. Semin Thromb Hemost. 2010; 36(7) 772-779
- 7 Salvagno G L, Berntorp E. Thrombin generation testing for monitoring hemophilia treatment: a clinical perspective. Semin Thromb Hemost. 2010; 36(7) 780-790
- 8 Kluft C, Meijer P. External quality assessment for thrombin generation tests: an exploration. Semin Thromb Hemost. 2010; 36(7) 791-796
- 9 Adams M. Assessment of thrombin generation: useful or hype?. Semin Thromb Hemost. 2009; 35(1) 104-110
- 10 Berntorp E, Salvagno G L. Standardization and clinical utility of thrombin-generation assays. Semin Thromb Hemost. 2008; 34(7) 670-682
- 11 Tripodi A. The history of phenotypic testing in thrombosis and hemostasis. Semin Thromb Hemost. 2008; 34(7) 585-592
- 12 Nowak G, Lange U, Wiesenburg A, Bucha E. Measurement of maximum thrombin generation capacity in blood and plasma using the thrombin generation assay (THROGA). Semin Thromb Hemost. 2007; 33(5) 508-514
- 13 Ruf W, Mueller B M. Thrombin generation and the pathogenesis of cancer. Semin Thromb Hemost. 2006; 32(Suppl 1) 61-68
- 14 Roberts H R, Hoffman M, Monroe D M. A cell-based model of thrombin generation. Semin Thromb Hemost. 2006; 32(Suppl 1) 32-38
- 15 Othman M. Molecular genetic testing in hemostasis and thrombosis: the past, the present, and the future. Semin Thromb Hemost. 2008; 34(6) 485-489
Emmanuel J FavaloroPh.D. M.A.I.M.S.
Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR)
Westmead Hospital, WSAHS, Westmead, NSW 2145, Australia
Email: emmanuel.favaloro@swahs.health.nsw.gov.au