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Near-Patient Thrombin Generation in Patients Undergoing Elective Cardiac Surgery.

Martijn Moorlag1,2, Evelien Schurgers1,2, Ganeshram Krishnamoorthy1,2

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A new whole blood thrombin generation assay provides rapid results and can predict postoperative blood loss in cardiothoracic surgery patients. This diagnostic tool aids in assessing bleeding risk and guiding clinical decisions.

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Area of Science:

  • Coagulation and Hemostasis Research
  • Clinical Diagnostics
  • Biomedical Engineering

Background:

  • Thrombin generation (TG) measurement is crucial for diagnosing thrombosis and hemostasis disorders.
  • The development of whole blood TG assays aims to incorporate all blood cell contributions.
  • Existing methods require significant time from blood draw to result.

Purpose of the Study:

  • To adapt and validate a rapid, whole blood thrombin generation assay for near-patient use.
  • To assess the assay's correlation with postoperative blood loss in cardiothoracic surgery patients.
  • To determine if specific TG parameters can predict bleeding severity.

Main Methods:

  • Modified the standard calibrated automated thrombography (CAT) calculation to focus on data up to the peak of TG.
  • Reduced the required blood volume per test to 15 μL for efficiency.
  • Evaluated assay performance by measuring interassay and interindividual variations and correlating results with blood loss in 33 patients.

Main Results:

  • The adapted assay demonstrated interassay variation below 15% and comparable interindividual variation to standard CAT.
  • Significant differences in peak endogenous thrombin potential (peakETP) and peak values were observed between severe and mild bleeders.
  • A combination of peakETP, body mass index, and lag time proved a superior predictor of blood loss compared to individual parameters.

Conclusions:

  • The adapted whole blood TG assay is suitable for near-patient testing.
  • The assay effectively indicates the extent of blood loss following cardiothoracic surgery.
  • This method offers a valuable tool for assessing bleeding risk in surgical patients.