Tripodi Armando
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Thromb Haemost. 2017 May 3;117(5):830-836. doi: 10.1160/TH16-10-0806. Epub 2017 Feb 23.
Each individual possesses his/her own endogenous-thrombin-potential (ETP) (i. e. the ability to generate thrombin) which depends on the relative strength of the pro- and anticoagulant drivers operating in plasma. This ability depends in turn on the clinical conditions in which the balance between the two drivers is variably affected. One of the major determinants of this balance is the factor (F)VIII-protein C(PC) axis and its effect can be conveniently explored by the thrombin generation procedures with results expressed as ETP ratio with/without thrombomodulin (TM) (ETP-TM ratio). Furthermore, owing to the many feedback mechanisms mediated by thrombin (e. g. activation of PC, FXI, FV, FVIII, platelets etc.) it is also possible that any perturbation of the balance between pro- and anticoagulants that may occur in plasma even outside the FVIII-PC axis could result in an increased ETP-TM ratio and therefore may suggest a procoagulant imbalance. Indeed, other non-coagulation moieties (e. g. microparticles, neutrophil extracellular traps, pro-inflammatory cytokines and others) circulating in blood of patients with various clinical conditions may also contribute to the procoagulant imbalance even when FVIII and/or PC are apparently normal. It can be postulated that dual ETP measurements performed in the presence and absence of TM with results expressed as their ratio may be the candidate procedure to detect subtle procoagulant imbalance in many clinical conditions characterised by an increased risk of thromboembolism. This article aimed at reviewing the clinical conditions in which evidence for the value of the ETP-TM ratio has been provided.
每个人都有自己的内源性凝血酶潜力（ETP）（即产生凝血酶的能力），这取决于血浆中促凝和抗凝驱动因素的相对强度。而这种能力又取决于临床状况，在这些状况下，两种驱动因素之间的平衡会受到不同程度的影响。这种平衡的主要决定因素之一是因子（F）VIII - 蛋白C（PC）轴，其作用可以通过凝血酶生成程序方便地进行探究，结果以有/无血栓调节蛋白（TM）时的ETP比值（ETP - TM比值）来表示。此外，由于凝血酶介导的许多反馈机制（例如PC、FXI、FV、FVIII、血小板等的激活），即使在FVIII - PC轴之外的血浆中发生的促凝和抗凝之间平衡的任何扰动，都有可能导致ETP - TM比值升高，因此可能提示促凝失衡。实际上，在各种临床状况患者的血液中循环的其他非凝血成分（例如微粒、中性粒细胞胞外陷阱、促炎细胞因子等），即使FVIII和/或PC明显正常，也可能导致促凝失衡。可以推测，在有和没有TM的情况下进行双重ETP测量，并将结果表示为它们的比值，可能是检测许多以血栓栓塞风险增加为特征的临床状况中细微促凝失衡的候选方法。本文旨在综述已提供ETP - TM比值价值证据的临床状况。
