Duarte Rita Carolina Figueiredo, Ferreira Cláudia Natália, Rios Danyelle Romana Alves, Reis Helton José Dos, Carvalho Maria das Graças
Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Universidade Federal de São João del-Rei (UFSJ), Divinópolis, MG, Brazil.
Rev Bras Hematol Hemoter. 2017 Jul-Sep;39(3):259-265. doi: 10.1016/j.bjhh.2017.03.009. Epub 2017 May 9.
The existing techniques to evaluate hemostasis in clinical laboratories are not sensitive enough to detect hypercoagulable and mild hypocoagulable states. Under different experimental conditions, the thrombin generation test may meet these requirements. This technique evaluates the overall balance between procoagulant and anticoagulant forces and has provided new insights in our understanding of the coagulation cascade, as well as of the diagnosis of hypocoagulability and hypercoagulability conditions. Thrombin generated in the thrombin generation test can be quantified as platelet-rich or platelet-poor plasma using the calibrated automated thrombogram method, which monitors the cleavage of a fluorogenic substrate that is simultaneously compared to the known thrombin activity in a non-clotting plasma sample. The calibrated automated thrombogram method is an open system, in which different antibodies, proteins, enzymes and peptides can be introduced to answer specific questions regarding hemostatic processes. The thrombin generation test has great clinical potential, such as in monitoring patients taking anticoagulants and antiplatelet drugs, screening for genetic or acquired thrombotic disorders, and evaluating bleeding risk control in patients with hemophilia using bypass agents or replacement therapy. Different to conventional coagulation tests, the thrombin generation test can be used for an overall evaluation of hemostasis, the results of which can then be used to evaluate specific characteristics of hemostasis, such as prothrombin time, activated partial thromboplastin time, and levels of fibrinogen and other coagulation factors. The introduction of this method will contribute to a better understanding and evaluation of overall hemostatic processes; however, this method still requires standardization and clinical validation.
临床实验室中用于评估止血功能的现有技术，对于检测高凝状态和轻度低凝状态不够敏感。在不同的实验条件下，凝血酶生成试验可能满足这些要求。该技术评估促凝和抗凝力量之间的总体平衡，并为我们理解凝血级联反应以及低凝和高凝状态的诊断提供了新的见解。凝血酶生成试验中生成的凝血酶，可以使用校准自动血栓图法在富含血小板或贫血小板血浆中进行定量，该方法监测荧光底物的裂解，并与非凝血血浆样本中已知的凝血酶活性同时进行比较。校准自动血栓图法是一个开放系统，可引入不同的抗体、蛋白质、酶和肽来回答有关止血过程的特定问题。凝血酶生成试验具有巨大的临床潜力，例如监测服用抗凝剂和抗血小板药物的患者、筛查遗传性或获得性血栓形成疾病，以及评估使用旁路剂或替代疗法的血友病患者的出血风险控制。与传统凝血试验不同，凝血酶生成试验可用于对止血功能进行全面评估，其结果可用于评估止血功能的特定特征，如凝血酶原时间、活化部分凝血活酶时间以及纤维蛋白原和其他凝血因子的水平。该方法的引入将有助于更好地理解和评估整体止血过程；然而，该方法仍需要标准化和临床验证。
