Wan Jun, Roberts Lara N, Hendrix Wasiliki, Konings Joke, Ow Tsai-Wing, Rabinowich Liane, Barbouti Omar, de Laat Bas, Arya Roopen, Patel Vishal C, Roest Mark, Lisman Ton, Bernal William
Synapse Research Institute, Maastricht, the Netherlands.
Cardiovascular Research Institute, Maastricht University, Maastricht, the Netherlands.
J Thromb Haemost. 2020 Apr;18(4):834-843. doi: 10.1111/jth.14751. Epub 2020 Feb 18.
Patients with cirrhosis have a rebalanced hemostasis, often with normal or elevated thrombin-generating (TG) capacity in plasma. Whole blood (WB) TG allows faster determination and, importantly, includes the influence of all circulating blood cells. We aimed to study the TG profile of patients with cirrhosis in WB and in platelet poor plasma.
Thrombin-generating capacity in WB and plasma were assessed with a near-patient WB-TG assay and the calibrated automated thrombinography assay, respectively. TG assays were tested in presence and absence of thrombomodulin. Conventional coagulation tests were also performed.
Thirty-four patients with cirrhosis and twenty-two controls were analyzed. Compared with controls, patients had substantially deranged results in conventional coagulation tests. Comparable WB-TG capacity (endogenous thrombin potential until peak, ETPp) but significantly lower peak thrombin were found in patients, and these results persisted when thrombomodulin was present. TG of the patients was more resistant to thrombomodulin than controls in both WB and plasma, although the inhibitory effect of thrombomodulin was drastically weaker in WB than in plasma. The peak of WB-TG in patients correlated moderately with their hematocrit and platelet count. Significant correlations were found between TG results in WB and plasma.
The WB-TG assay shows a normal to hypocoagulable state in patients with cirrhosis with a decreased anticoagulant activity of TM compared to plasma-TG. The clinical value of this assay needs further validation.
肝硬化患者的止血功能重新平衡，血浆中凝血酶生成（TG）能力通常正常或升高。全血（WB）TG检测速度更快，重要的是，它包含了所有循环血细胞的影响。我们旨在研究肝硬化患者全血和血小板缺乏血浆中的TG谱。
分别采用即时全血TG检测法和校准自动凝血酶生成检测法评估全血和血浆中的凝血酶生成能力。在有和没有血栓调节蛋白的情况下进行TG检测。还进行了传统凝血试验。
分析了34例肝硬化患者和22例对照。与对照组相比，患者的传统凝血试验结果明显异常。患者的全血TG能力（至峰值的内源性凝血酶潜力，ETPp）相当，但峰值凝血酶明显较低，且在存在血栓调节蛋白时这些结果依然存在。在全血和血浆中，患者的TG对血栓调节蛋白的耐药性均高于对照组，尽管血栓调节蛋白在全血中的抑制作用比在血浆中弱得多。患者全血TG峰值与其血细胞比容和血小板计数呈中度相关。全血和血浆中的TG结果之间存在显著相关性。
与血浆TG相比，全血TG检测显示肝硬化患者处于正常至低凝状态，血栓调节蛋白的抗凝活性降低。该检测方法的临床价值需要进一步验证。
