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Thrombin generation as marker to estimate thrombosis risk in patients with abnormal test results in lupus anticoagulant routine diagnostics.

Boeer K, Cuznetov L, Loesche W - Thromb J (2013)

Bottom Line: Samples from 63 patients (39 with abnormal test results; 24 controls) were included in the study.In addition, measurement of anticardiolipin-IgM, -IgG and β2-glycoprotein-I-IgM, -IgG were performed.Thrombin generation was measured using two different phospholipid concentrations in the starting reagent.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut für Klinische Chemie und Laboratoriumsdiagnostik, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany. klas.boeer@med.uni-jena.de.

ABSTRACT

Background: Lupus anticoagulant (LA) is known to inhibit thrombin generation although patients have an increased risk to develop thrombosis. We tried to determine whether thrombin generation is altered in plasma samples of patients with abnormal test results in LA routine diagnostics and whether its measurement may improve the risk assessment of thrombosis.

Methods: Samples from 63 patients (39 with abnormal test results; 24 controls) were included in the study. Measurement of diluted Russel's viper venom time (dRVVT) was part of the initial guideline conform diagnostic procedure for detection of LA. In addition, measurement of anticardiolipin-IgM, -IgG and β2-glycoprotein-I-IgM, -IgG were performed. Thrombin generation was measured using two different phospholipid concentrations in the starting reagent.

Results: Analyzing all samples by logistic regression, thrombin generation after induction with high phospholipid concentrations was the best predictor of thrombosis. After preselection of samples with alterations in dRVVT, specificity of selected thrombin generation derived parameters for the detection of previous thrombosis increased in this subgroup.

Conclusions: In patients with phospholipid-dependent prolongation of dRVVT, thrombin generation is variably inhibited and the degree of inhibition corresponds to the occurrence of previous thrombosis. Measuring thrombin generation in patients with phospholipid-dependent dRVVT prolongation may improve risk assessment of thrombosis.

No MeSH data available.


Related in: MedlinePlus

Box-Whisker- and dot plots of 4 TG-derived parameters (lag time, time to peak, peak thrombin, AUC of thrombin generation) and LAC Screen ratio after induction with 2 different starting reagents (RC-low = low phospholipid concentration, RC-high = high phospholipid concentration). Significance level was 0.05.
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Figure 2: Box-Whisker- and dot plots of 4 TG-derived parameters (lag time, time to peak, peak thrombin, AUC of thrombin generation) and LAC Screen ratio after induction with 2 different starting reagents (RC-low = low phospholipid concentration, RC-high = high phospholipid concentration). Significance level was 0.05.

Mentions: TG-derived parameters differed significantly (except peak thrombin generation with RC-low reagent) between samples from patients with and without thrombosis (Figure 2) while there was no significant difference in LAC Screen ratio. Further analysis of the dot plots revealed a wide spreading of the results most noticeably for the TG-derived parameters time to peak and AUC. Therefore, samples were further subdivided into LAC Screen ratio negative (< 1.2) and positive (> =1.2) samples with and without history of thrombosis.


Thrombin generation as marker to estimate thrombosis risk in patients with abnormal test results in lupus anticoagulant routine diagnostics.

Boeer K, Cuznetov L, Loesche W - Thromb J (2013)

Box-Whisker- and dot plots of 4 TG-derived parameters (lag time, time to peak, peak thrombin, AUC of thrombin generation) and LAC Screen ratio after induction with 2 different starting reagents (RC-low = low phospholipid concentration, RC-high = high phospholipid concentration). Significance level was 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3842625&req=5

Figure 2: Box-Whisker- and dot plots of 4 TG-derived parameters (lag time, time to peak, peak thrombin, AUC of thrombin generation) and LAC Screen ratio after induction with 2 different starting reagents (RC-low = low phospholipid concentration, RC-high = high phospholipid concentration). Significance level was 0.05.
Mentions: TG-derived parameters differed significantly (except peak thrombin generation with RC-low reagent) between samples from patients with and without thrombosis (Figure 2) while there was no significant difference in LAC Screen ratio. Further analysis of the dot plots revealed a wide spreading of the results most noticeably for the TG-derived parameters time to peak and AUC. Therefore, samples were further subdivided into LAC Screen ratio negative (< 1.2) and positive (> =1.2) samples with and without history of thrombosis.

Bottom Line: Samples from 63 patients (39 with abnormal test results; 24 controls) were included in the study.In addition, measurement of anticardiolipin-IgM, -IgG and β2-glycoprotein-I-IgM, -IgG were performed.Thrombin generation was measured using two different phospholipid concentrations in the starting reagent.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut für Klinische Chemie und Laboratoriumsdiagnostik, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany. klas.boeer@med.uni-jena.de.

ABSTRACT

Background: Lupus anticoagulant (LA) is known to inhibit thrombin generation although patients have an increased risk to develop thrombosis. We tried to determine whether thrombin generation is altered in plasma samples of patients with abnormal test results in LA routine diagnostics and whether its measurement may improve the risk assessment of thrombosis.

Methods: Samples from 63 patients (39 with abnormal test results; 24 controls) were included in the study. Measurement of diluted Russel's viper venom time (dRVVT) was part of the initial guideline conform diagnostic procedure for detection of LA. In addition, measurement of anticardiolipin-IgM, -IgG and β2-glycoprotein-I-IgM, -IgG were performed. Thrombin generation was measured using two different phospholipid concentrations in the starting reagent.

Results: Analyzing all samples by logistic regression, thrombin generation after induction with high phospholipid concentrations was the best predictor of thrombosis. After preselection of samples with alterations in dRVVT, specificity of selected thrombin generation derived parameters for the detection of previous thrombosis increased in this subgroup.

Conclusions: In patients with phospholipid-dependent prolongation of dRVVT, thrombin generation is variably inhibited and the degree of inhibition corresponds to the occurrence of previous thrombosis. Measuring thrombin generation in patients with phospholipid-dependent dRVVT prolongation may improve risk assessment of thrombosis.

No MeSH data available.


Related in: MedlinePlus