Hypercoagulability (thrombin generation) in patients with cirrhosis is detected with ST-Genesia

Laurie Talon, Thomas Sinegre, Thomas Lecompte, Bruno Pereira, Sylvie Massoulié, Armand Abergel, Aurélien Lebreton, Laurie Talon, Thomas Sinegre, Thomas Lecompte, Bruno Pereira, Sylvie Massoulié, Armand Abergel, Aurélien Lebreton

Abstract

Background: Thrombin generation assays (TGAs) performed with calibrated automated thrombography (CAT) in the presence of thrombomodulin (TM) indicate plasma hypercoagulability in cirrhosis.

Objective: To evaluate, in the presence of TM, the new ST-Genesia automated device developed for improving TGA vs the previously used CAT method, with plasma samples of patients with cirrhosis.

Patients/methods: Platelet-poor plasma samples were prepared from citrated blood samples of 52 healthy controls and 85 patients with cirrhosis (severity evaluated using the Child-Pugh score [CP]). TGAs were performed using CAT with PPP-Reagent and ST-Genesia with the STG-ThromboScreen reagent, in the presence of TM. Endogenous thrombin potential (ETP) was chosen as the main parameter.

Results: Whatever the method, ETP values were higher in patients than in healthy controls. All patients identified as hypercoagulable with ST-Genesia and STG-ThromboScreen were found hypercoagulable with CAT and PPP-Reagent. Conversely, eight and ten patients in the CP-A and CP-B classes respectively were identified as hypercoagulable only with CAT. The use of ST-Genesia with the STG-ThromboScreen reagent with TM led to a bias, with higher ETP values for healthy controls and lower for patients compared with CAT. Crossover analysis (CAT with the STG-ThromboScreen reagent) evidenced a substantial effect of the STG-ThromboScreen reagent; the analyzer (including calibration and data analysis) plays a lesser role.

Conclusion: ST-Genesia evidences hypercoagulability in patients with cirrhosis when TG is studied in the presence of TM, but the results are not interchangeable with those obtained with CAT.

Keywords: blood coagulation; blood coagulation test; clinical laboratory techniques; liver cirrhosis; thrombomodulin.

© 2020 International Society on Thrombosis and Haemostasis.

References

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