Endogenous thrombin potential and screening parameters of coagulation [Potenziale endogeno di trombina e parametri di screening della coagulazione]

Background.: Thrombin is a pivotal player in the coagulation system. The activity of thrombin is the measurement of its concentration in function of time. The area under thrombin generation curve is called the endogenous thrombin potential (ETP). ETP is a global test and reflects the functions of the haemostatic system much better that the classical clotting tests. ETP increases in each ipercoagulability condition and decreases in each ipocoagulability condition. The measurement of ETP is the potentially applicable to clinical laboratories, but the technical limits haven't made it possible the routinely use, also if many clinical studies are executed in research and/or specialistic laboratories. Recent developments offer the possibility to evaluate ETP in automated coagulometers. In this study, we evaluate the possibility of application of ETP on an automated coagulometer and compare ETP value with the classical screening parameters of coagulation. Methods.: ETP was measured in 106 subjects: 60 males and 56 females, between 31-50 years of age, not using drugs known to affect the coagulation system and without history of thrombosis or bleeding disorder. Blood was taken by venipuncture and collected into sodium citrate (3.2%) tubes. Plasma was obtained by centrifugation at room temperature for 15 min at 2500 g and used immediately after centrifugation or frozen at -80 C and then defrosted at 37 C for 5 min. The dosage of prothrombin time, activated partial thromboplastin time, fibrinogen, d-dimer, ETP are performed on an automated coagulation analyzer BCS XP System (Siemens Healthcare Diagnostic, Marburg, Germany), with reagents and protocols from the manufacturer (Siemens Healthcare Diagnostics). Results.: In about three hours it is possible analyzer 106 subjects. No statistically significant difference is observed between results in women and men. The ETP values are expressed as AUC% and reference range is 80-110%. Conclusions.: Our study clearly shows the possibility to use automated coagulometer for ETP assay. ETP performed with a automated coagulometer is a rapid, suitable and reliable tool for screening coagulation, making possible this test in routine laboratory. This new opportunity has to carefully evaluate and could be made it possible to measurement ETP routinely at high throughput and thus transformed it from a research tool into a tool for clinical use for management of hemorrhagic or thrombotic diseases; hemorrhagic or venous thrombosis risk; congenital coagulophaties; use of conventional or new anticoagulants. This study represents the first step to build normal range for automated coagulometer. The potential utility of measurement of ETP in clinical settings should be investigated on a major number of subjects. © 2013 Springer-Verlag Italia.