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Correlation between Thrombin Generation, Standard Coagulation Assays, and Viscoelastic Assays for Hemostatic
Kimberly A Thomas1, Susan M Shea1, Arun Saini2
1Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
Insights
Thrombin generation (TG) assays correlate variably with standard coagulation tests in critically ill children. Thromboelastography kinetic time (TEG-K) showed the most consistent correlation with endogenous thrombin potential (ETP).
Area of Science:
- Pediatric critical care medicine
- Hemostasis and thrombosis research
- Clinical laboratory diagnostics
Background:
- Accurate assessment of hemostatic function is crucial for managing coagulopathies in critically ill children.
- Thrombin generation (TG) assays offer a global evaluation of procoagulant and anticoagulant factors, widely used in research.
- This study aimed to correlate standard hemostasis assays with TG in pediatric intensive care unit patients.
Purpose of the Study:
- To evaluate the correlation between clinically available hemostasis assays and thrombin generation (TG) in critically ill children.
- To determine which assays best reflect the global hemostatic status as assessed by TG.
Main Methods:
- A prospective, 2-center study enrolled 106 critically ill children (March 2016-December 2019).
- Assays included prothrombin time, activated thromboplastin time, anti-Xa, viscoelastic assays (thromboelastography [TEG], rotational thromboelastometry [ROTEM]), and TG (endogenous thrombin potential [ETP]).
- Patients were stratified into non-anticoagulated, anticoagulated without extracorporeal life support, and anticoagulated with extracorporeal life support groups.
Main Results:
- Endogenous thrombin potential (ETP) was significantly lower in anticoagulated patients compared to non-anticoagulated patients (P < 0.0001).
- Across all patients, ETP showed the strongest correlation with TEG kinetic time (TEG-K; ρ = -0.639) and TEG reaction time (ρ = -0.596).
- Group-specific correlations varied, with ETP correlating best with international normalized ratio in non-anticoagulated patients, TEG-K in those anticoagulated without extracorporeal life support, and anti-Xa in those with extracorporeal life support.
Conclusions:
- Standard and viscoelastic hemostasis assays demonstrate variable correlations with thrombin generation (TG) in critically ill children.
- Thromboelastography kinetic time (TEG-K) exhibited the most consistent moderate correlation with endogenous thrombin potential (ETP) across all patient groups.
- These findings highlight the complexity of assessing hemostasis in critically ill children and suggest TEG-K as a potentially valuable indicator of TG.
Background:
Accurate assessment of hemostatic function is essential to guide care in critically ill children with acute and acquired coagulopathies. Thrombin generation (TG) provides a global assessment of procoagulant and anticoagulant factors and is commonly used in hemostasis research laboratories. Our objective was to determine the correlation of clinically available hemostasis assays with TG in critically ill children.
Methods:
Children (<18 years old, >3 kg in weight) in the intensive care unit were enrolled from March 2016 to December 2019 in a prospective 2-center study. Coagulation tests were prothrombin time, activated thromboplastin time, anti-Xa assay, viscoelastic assays (thromboelastography [TEG], rotational thromboelastometry [ROTEM]), and TG (induced by 20 pM tissue factor in platelet poor plasma and reported as endogenous thrombin potential [ETP; nM*min]). Data are reported as median (interquartile range) or Spearman coefficient (ρ).
Results:
Patients (n = 106, age 10.2 years [3.8-15.3]) were divided into 3 groups: (a) no anticoagulation (n = 46), (b) anticoagulation (unfractionated heparin) without extracorporeal life support (n = 34), or (c) with extracorporeal life support (n = 26). ETP was decreased in anticoagulated compared to non-anticoagulated patients (group 1: 902.4 [560.8-1234], group 2: 315.6 [0.0-962.2], group 3: 258.5 [0.0-716.6]; P < 0.0001). Across all patients, ETP correlated best with TEG kinetic time (TEG-K), in min (ρ = -0.639), followed by TEG reaction time, in min (ρ = -0.596). By group, ETP correlated best with international normalized ratio for group 1 (ρ = -0.469), TEG-K time for group 2 (ρ = -0.640), and anti-Xa for group 3 (ρ = -0.793).
Conclusions:
Standard and viscoelastic assays have varying correlation with TG in critically ill children. TEG-K time had the most consistent moderate correlation with ETP across all groups.
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