Driever Ellen G, Larsen Julie Brogaard, Bos Sarah, Bernal William, Hvas Anne-Mette, Lisman Ton
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Res Pract Thromb Haemost. 2023 Jan 11;7(1):100043. doi: 10.1016/j.rpth.2023.100043. eCollection 2023 Jan.
A plasma-based clot lysis time (CLT) assay is an established research test to assess plasma fibrinolytic potential, with application in hyperfibrinolytic or hypofibrinolytic conditions. Interprotocol variations make comparisons between laboratories challenging. The aim of this study was to compare the results of 2 different CLT assays performed by 2 distinct research laboratories by using their own protocol.
We evaluated fibrinolysis in the plasma of 60 patients undergoing hepatobiliary surgery and in plasma from a healthy donor that was spiked with commonly used anticoagulant drugs (enoxaparin, dabigatran, and rivaroxaban) in 2 distinct laboratories (Aarhus and Groningen) by using 2 different assays that differ, among others, in tissue plasminogen activator (tPA) concentration.
Overall conclusions on fibrinolytic potential in patients undergoing hepatobiliary surgery were similar between the 2 CLT assays, with hyperfibrinolytic and hypofibrinolytic profiles identified at the same time points during and after surgery. Severe hypofibrinolysis was less commonly reported in the Aarhus assay (36/319 samples; 11%) than in the Groningen assay (55/319 samples; 17%). No clot formation was observed in 31 of 319 samples in the Aarhus assay vs 0 of 319 samples in the Groningen assay. Clotting times increased much more profoundly on the addition of all 3 anticoagulants in the Aarhus assay.
Despite the differences in laboratory, protocol, reagents, operator, data processing, and analysis, overall conclusions on fibrinolytic capacity are similar between the 2 laboratories. With a higher concentration of tPA in the Aarhus assay, the test becomes less sensitive for the detection of hypofibrinolysis and is more sensitive to the addition of anticoagulants.
基于血浆的凝块溶解时间（CLT）测定是一种既定的研究测试，用于评估血浆纤维蛋白溶解潜力，适用于高纤维蛋白溶解或低纤维蛋白溶解状态。不同方案之间的差异使得实验室间的比较具有挑战性。本研究的目的是通过使用各自的方案，比较两个不同研究实验室进行的两种不同CLT测定的结果。
我们在两个不同的实验室（奥胡斯和格罗宁根）中，使用两种不同的测定方法（其中组织纤溶酶原激活物（tPA）浓度不同），评估了60例接受肝胆手术患者的血浆以及添加了常用抗凝药物（依诺肝素、达比加群和利伐沙班）的健康供者血浆中的纤维蛋白溶解情况。
两种CLT测定对接受肝胆手术患者纤维蛋白溶解潜力的总体结论相似，在手术期间和术后的相同时间点识别出高纤维蛋白溶解和低纤维蛋白溶解情况。奥胡斯测定中严重低纤维蛋白溶解的报告频率（36/319个样本；11%）低于格罗宁根测定（55/319个样本；17%）。在奥胡斯测定的319个样本中有31个未观察到凝块形成，而在格罗宁根测定的319个样本中未观察到凝块形成的样本数为0。在奥胡斯测定中添加所有三种抗凝剂后，凝血时间的增加更为显著。
尽管在实验室、方案、试剂、操作人员、数据处理和分析方面存在差异，但两个实验室对纤维蛋白溶解能力的总体结论相似。由于奥胡斯测定中tPA浓度较高，该测试对低纤维蛋白溶解的检测敏感性较低，对抗凝剂添加更为敏感。
