Ferrara Michael J, MacArthur Taleen A, Butenas Saulius, Mann Kenneth G, Immermann Joseph M, Spears Grant M, Bailey Kent R, Kozar Rosemary A, Heller Stephanie F, Loomis Erica A, Stephens Daniel, Park Myung S
Mayo Clinic Rochester MN USA.
University of Vermont Colchester VT USA.
Res Pract Thromb Haemost. 2021 Mar 8;5(3):395-402. doi: 10.1002/rth2.12483. eCollection 2021 Mar.
Plasma thrombin generation kinetics as measured by the calibrated automated thrombogram (CAT) assay is a predictor of symptomatic venous thromboembolism after trauma. We hypothesized that data from a new prototype assay for measurement of thrombin generation kinetics in fresh whole blood (near patient testing of thrombin generation), will correlate with the standard CAT assay in the same patients, making it a potential tool in the future care of trauma patients.
Patients were enrolled from June 2018 to February 2020. Within 12 hours of injury, blood samples were collected simultaneously for both assays. Variables compared and correlated between assays were lag time, peak height, time to peak, and endogenous thrombin potential. Data are presented as median with interquartile range (IQR). Spearman and Pearson correlations were estimated and tested between both assays; a value of <0.05 was considered to be significant.
A total of 64 trauma patients had samples analyzed: injury severity score = 17 (IQR), 10-26], hospital length of stay = 7.5 (IQR), 2-18) days, age = 52 (IQR, 35-63) years, 71.9% male, and 42.2% of patients received a transfusion within 24 hours of injury. Thrombin generation parameters between plasma and whole blood were compared and found that all parameters of the two assays correlate in trauma patients.
In this pilot study, we have found that a novel point-of-care whole blood thrombin generation assay yields results with modest but statistically significant correlations to those of a standard plasma thrombin generation assay. This finding supports studying this device in a larger, adequately powered study.
通过校准自动血栓图（CAT）测定法测得的血浆凝血酶生成动力学是创伤后症状性静脉血栓栓塞的一个预测指标。我们假设，一种用于测量新鲜全血中凝血酶生成动力学的新型原型测定法（凝血酶生成的床旁检测）所获得的数据，将与同一患者的标准CAT测定法相关，使其成为未来创伤患者护理中的一个潜在工具。
研究对象为2018年6月至2020年2月期间入组的患者。在受伤后12小时内，同时采集血样用于两种测定法。对两种测定法之间进行比较和关联的变量包括滞后时间、峰值高度、达到峰值的时间和内源性凝血酶潜力。数据以中位数和四分位间距（IQR）表示。对两种测定法之间进行Spearman和Pearson相关性估计及检验；P值<0.05被认为具有统计学意义。
共有64例创伤患者的样本进行了分析：损伤严重程度评分=17（IQR，10 - 26），住院时间=7.5（IQR，2 - 18）天，年龄=52（IQR，35 - 63）岁，男性占71.9%，42.2%的患者在受伤后24小时内接受了输血。对血浆和全血之间的凝血酶生成参数进行比较，发现两种测定法的所有参数在创伤患者中均具有相关性。
在这项初步研究中，我们发现一种新型的床旁全血凝血酶生成测定法所得到的结果与标准血浆凝血酶生成测定法的结果具有适度但具有统计学意义的相关性。这一发现支持在更大规模、有足够效力的研究中对该设备进行研究。
