Thrombin generation testing in routine clinical practice: are we there yet?
Article first published online: 28 JUN 2008
© 2008 The Authors. Journal Compilation © 2008 Blackwell Publishing Ltd
British Journal of Haematology
Volume 142, Issue 6, pages 889–903, September 2008
How to Cite
Van Veen, J. J., Gatt, A. and Makris, M. (2008), Thrombin generation testing in routine clinical practice: are we there yet?. British Journal of Haematology, 142: 889–903. doi: 10.1111/j.1365-2141.2008.07267.x
- Issue published online: 21 AUG 2008
- Article first published online: 28 JUN 2008
- thrombin generation;
- endogenous thrombin potential;
- coagulation phenotype;
- haemorrhagic disorders;
Thrombin is the central enzyme in the coagulation cascade. Estimation of an individual’s potential to generate thrombin may correlate more closely with a hyper- or hypo-coagulable phenotype, compared to traditional coagulation tests. The possible correlation and recent technical advances in thrombin generation measurement has caused a significant interest in the method and the development of commercial assays. Several variations of the assay exist depending on the defect to be investigated. Fluorogenic thrombin generation assays have acceptable intra-laboratory variation but a higher inter-laboratory variation. Variation in preanalytical variables makes comparisons between studies difficult. Thrombin generation is highly variable between individuals and there are suggestions that this may allow individualized treatment based on global haemostatic response in patients with bleeding disorders or on anticoagulant therapy. In patients with thrombotic disorders it may be possible to identify those at higher risk of recurrent thrombosis. For both scenarios, however, data from large prospective studies are lacking or inconclusive and a good relationship between thrombin generation and phenotype remains to be established. Further standardization of the assay is needed before large multicentre studies can be conducted and until then thrombin generation in routine clinical practice is not yet a reality.