Altered thrombin generation with prothrombin complex concentrate is not detected by viscoelastic testing: an in vitro...

Area of Science:

• Coagulation science
• Hemostasis research
• Critical care medicine

Background:

• Current bleeding guidelines recommend viscoelastic testing (VET) for managing severe hemorrhage.
• VET parameters like clotting time (CT) and activated clotting time (ACT) may not fully represent procoagulant and anticoagulant interactions.
• Thrombin generation assays offer a more comprehensive view of hemostasis.

Purpose of the Study:

• To assess the ability of CT and ACT to indicate thrombin generation activity.
• To compare VET parameters with thrombin generation after blood dilution and prothrombin complex concentrate (PCC) administration.

Main Methods:

• Citrated whole blood from 13 healthy volunteers was diluted by 50% with crystalloid.
• Blood was spiked with four-factor prothrombin complex concentrate (4F-PCC).
• Thrombin generation was measured and compared with CT and ACT from four VET devices and standard coagulation tests.

Main Results:

• Blood dilution increased thrombin generation parameters (velocity index, peak height, endogenous thrombin potential).
• CT and ACT significantly prolonged after dilution on all VET devices.
• 4F-PCC addition did not affect CT or ACT but improved standard coagulation tests.

Conclusions:

• Thrombin generation increases after PCC spiking were not reflected by CT or ACT.
• Current treatment algorithms using prolonged CT or ACT to guide PCC administration are not supported.
• VET parameters may not be reliable indicators for augmenting thrombin generation with PCC.