Can We Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests?

Abstract

Hemostasis is a complex process in which abnormalities can cause shifts toward prothrombotic or prohemorrhagic states resulting in thrombosis or bleeding, respectively. Several coagulation tests may be required to characterize these defects but may yet not always reflect a patient's true hemostatic capacity. Thus, global coagulation tests aiming to simulate the coagulation process in vitro instead of measuring single components thereof are certainly of interest to assess prothrombotic or prohemorrhagic tendencies. This review describes the development and application of global coagulation tests, concentrating on the more widely used methods of viscoelastometry and thrombin generation. A focus is placed on conditions characterized by simultaneous changes of various components of hemostasis, such as anticoagulant therapy or hormone-induced coagulopathy, in which global coagulation tests are especially promising. If the key challenges of standardization and automation of these tests are solved, as is the case with automated thrombogram or clot waveform analysis, global coagulation assays will play an important role in the future of laboratory diagnostics of hemostasis and thrombosis.

Zusammenfassung

Die Hämostase ist ein komplexer Prozess, bei dem Anomalien prothrombotische oder prohämorrhagische Zustände auslösen können, die zu einer Thrombose oder Blutung führen. Die Diagnose solcher Störungen kann mehrere Labortests erforderlich machen, die dennoch nicht immer die tatsächliche Hämostasekapazität eines Patienten widerspiegeln. Daher zielen Globalteste der Gerinnung darauf ab, den Gerinnungsprozess in vitro zu simulieren, anstatt einzelne daran beteiligte Komponenten zu messen. Diese Übersichtsarbeit beschreibt Entwicklung und Einsatz dieser Globalteste, wobei sie sich auf die verbreiteten Methoden der Viskoelastometrie und Thrombingenerierung konzentriert. Im Fokus stehen Zustände mit gleichzeitigen Veränderungen verschiedener Hämostasekomponenten, etwa Antikoagulanzientherapie oder Hormon-induzierte Koagulopathie, bei denen der Einsatz von Globaltesten besonders vielversprechend ist. Falls es, wie beim Automated Thrombogram oder der Clot Waveform Analyse, gelingt, die zentralen Herausforderungen der Standardisierung und Automatisierung zu lösen, werden Globalteste der Gerinnung eine wichtige Rolle in der Zukunft der Labordiagnostik von Hämostase und Thrombose spielen.

Keywords

global coagulation tests - hypercoagulability - bleeding - anticoagulant drugs - hormone-induced coagulopathy

Schlüsselwörter

Globalteste der Gerinnung - Hyperkoagulabilität - Blutung - Antikoagulanzien - Hormon-induzierte Koagulopathie

^* Both authors contributed equally to this article.

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