Hemker H Coenraad, Al Dieri Raed, De Smedt Erik, Béguin Suzette
Cardiovascular Research Institute (CARIM), P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Thromb Haemost. 2006 Nov;96(5):553-61.
By the use of a fluorogenic thrombin substrate and continuous calibration of each individual sample, it is now possible to obtain a thrombin generation (TG) curve (or thrombogram) in plasma, with or without platelets, in an easy routine procedure at high throughput and with an acceptable experimental error (<5%). Evidence is growing that the parameters of the thrombogram, and notably the area under the curve (endogenous thrombin potential, ETP), are useful in assessing bleeding- or thrombotic risk and its modification by antithrombotic- or haemostatic treatment. Available data strongly suggest that conditions (congenital, acquired, drug-induced) that increase TG all cause a thrombotic tendency and that conditions that decrease TG prevent thrombosis but, beyond a limit, cause bleeding. Diminution of TG is a common denominator of all antithrombotic treatment, including anti-platelet drugs. The thrombogram can also be used as a tool in the search for new antithrombotics and reflects the haemorrhagic or thrombotic side effects of other drugs (e.g. oral contraceptives). The thrombogram thus is a promising new approach to clinical management of bleeding and thrombotic disease as well as a tool in drug research and epidemiology. Our experience at this moment is insufficient, however, to already clearly define its limits.
通过使用荧光凝血酶底物并对每个样本进行连续校准，现在可以在高通量且实验误差可接受（<5%）的简单常规程序中，在有或无血小板的血浆中获得凝血酶生成（TG）曲线（或血栓图）。越来越多的证据表明，血栓图的参数，尤其是曲线下面积（内源性凝血酶潜力，ETP），在评估出血或血栓形成风险以及抗血栓或止血治疗对其的改变方面很有用。现有数据强烈表明，增加TG的情况（先天性、后天性、药物诱导性）都会导致血栓形成倾向，而降低TG的情况可预防血栓形成，但超过一定限度会导致出血。TG降低是所有抗血栓治疗（包括抗血小板药物）的共同特征。血栓图还可作为寻找新型抗血栓药物的工具，并反映其他药物（如口服避孕药）的出血或血栓形成副作用。因此，血栓图是出血和血栓性疾病临床管理的一种有前景的新方法，也是药物研究和流行病学中的一种工具。然而，目前我们的经验还不足以明确界定其局限性。
