Comparison of Two Thrombin Generation Methods, CAT and ST-Genesia, in Liver Transplant Patients
21. Oktober 2018
22. Februar 2019
20. April 2019 (online)
Background During liver transplantation (LT), thrombin generation (TG) is altered. The most frequently used assay for TG is the Calibrated Automated Thrombogram (CAT). It is designed for series of plasmas and is semi-automated. Complete automation has led to a new device, the ST-Genesia, enabling quantitative standardized TG evaluation.
Objective The aim of this observational study was to compare the TG results of the CAT and the ST-Genesia on frozen-thawed plasma samples prepared from the blood of LT patients.
Patients and Methods Poor platelet plasma aliquots were prepared from blood samples from six LT patients selected to get the whole range of TG and were assessed with CAT (recombinant human tissue factor [TF] concentration 5 pm) and with ST-Genesia Bleedscreen assay (BS, using ‘low’ recombinant human TF concentration) and Thromboscreen assay (TS, using ‘medium’ recombinant human TF concentration). The TG parameters studied were: lag time, peak, time to peak, endogenous thrombin potential, velocity index and start tail.
Results BS and TS did not differ significantly from each other whatever the parameter studied, whereas most of the CAT parameters were significantly different from those obtained with BS and TS. Hierarchical clustering analysis of the different parameters of TG showed three homogeneous groups. One cluster gathered TG quantitative parameters from ST-Genesia. A second cluster gathered all the kinetic parameters. The last cluster isolated the quantitative parameters of CAT.
Conclusion In patients undergoing LT, TG performed with CAT and with ST-Genesia provided different results, for unknown reasons.
S. Roullet designed the study, recruited patients, provided patient samples, performed experiments and analysis and wrote the manuscript. S. Labrouche performed experiments and analysis. G. Freyburger designed the study, performed experiments and analysis and wrote the manuscript.
- 1 Clevenger B, Mallett SV. Transfusion and coagulation management in liver transplantation. World J Gastroenterol 2014; 20 (20) 6146-6158
- 2 Hemker HC, Giesen P, Al Dieri R. , et al. Calibrated automated thrombin generation measurement in clotting plasma. Pathophysiol Haemost Thromb 2003; 33 (01) 4-15
- 3 Hemker HC, Béguin S. Thrombin generation in plasma: its assessment via the endogenous thrombin potential. Thromb Haemost 1995; 74 (01) 134-138
- 4 Hemker HC, Giesen P, AlDieri R. , et al. The calibrated automated thrombogram (CAT): a universal routine test for hyper- and hypocoagulability. Pathophysiol Haemost Thromb 2002; 32 (5-6): 249-253
- 5 Kremers RMW, Kleinegris M-C, Ninivaggi M. , et al. Decreased prothrombin conversion and reduced thrombin inactivation explain rebalanced thrombin generation in liver cirrhosis. PLoS One 2017; 12: e0177020
- 6 Coen Hemker H, Hemker PW, Al Dieri R. The technique of measuring thrombin generation with fluorescent substrates: 4. The H-transform, a mathematical procedure to obtain thrombin concentrations without external calibration. Thromb Haemost 2009; 101 (01) 171-177
- 7 Hemker HC, Kremers R. Data management in thrombin generation. Thromb Res 2013; 131 (01) 3-11
- 8 Liu Y-H, MacFie HJH. Methods for averaging time – intensity curves. Chem Senses 1990; 15: 471-484
- 9 Roullet S, Labrouche S, Mouton C. , et al. Lysis Timer: a new sensitive tool to diagnose hyperfibrinolysis in liver transplantation. J Clin Pathol 2019; 72 (01) 58-65
- 10 Lisman T, Bakhtiari K, Pereboom IT, Hendriks HG, Meijers JC, Porte RJ. Normal to increased thrombin generation in patients undergoing liver transplantation despite prolonged conventional coagulation tests. J Hepatol 2010; 52 (03) 355-361
- 11 Tripodi A, Primignani M, Chantarangkul V. , et al. Thrombin generation in patients with cirrhosis: the role of platelets. Hepatology 2006; 44 (02) 440-445
- 12 Lisman T, Porte RJ. Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences. Blood 2010; 116 (06) 878-885
- 13 Freyburger G, Macouillard G, Labrouche S, Sztark F. Coagulation parameters in patients receiving dabigatran etexilate or rivaroxaban: two observational studies in patients undergoing total hip or total knee replacement. Thromb Res 2011; 127 (05) 457-465
- 14 Siguret V, Foulon G, Abdoul J. , et al. PB584 | Thrombin generation analysis with a new automated system (ST-Genesia): inter-series performances during DRIVING study and comparison with CAT system. Res Pract Thromb Haemost 2018; 2: 285-286
- 15 MacDonald S, Mullins J, Bravin A. , et al. P118. Standardization and automation of thrombin generation assay: TG on its way to the clinical lab for haemophilia patients. Marseille, France: ECTH 2018 Abstr Book; 2018: 148
- 16 Arus M, Vilalta N, Romero L. , et al. P217. Comparison between the standard thrombin generation method and the automated thrombin generation technique. Marseille, France: ECTH 2018 Abstr Book; 2018: 238