Anticoagulated patients exhibit intact endogenous thrombin potential using ST Genesia unlike the Calibrated Automated Thrombogram

Figures

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  FIGURE 1. DOAC response in 31 samples as assessed using ST Genesia DrugScreen. Increasing DOAC concentrations were correlated with (A) prolonged lag time (R2 = 0.33) and (B) greater time to peak (R2 = 0.53), and (C) lower peak (R2 = 0.45). (D) ETP responses varied widely (R2 = 0.08). The line shows the reference values reported in the literature. 6 DOAC, direct oral anticoagulant; ETP, endogenous thrombin potential

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  FIGURE 2. Thrombin generation profiles using ST Genesia DrugScreen and Calibrated Automated Thrombogram (CAT) in warfarin and heparin samples. ST Genesia Drugscreen and CAT exhibited trends of diminishing thrombin generation (TG) with increasing anticoagulation, although the magnitude of TG differed. ST Genesia Drugscreen did not provide results in samples with anticoagulant levels with an international normalized ratio (INR) >3.0, whereas CAT yielded results at INRs up to 6.5

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  FIGURE 3. Thrombin generation in both ST Genesia DrugScreen and Calibrated Automated Thrombogram (CAT) assessed in 20 samples. The interpretation of the results differed somewhat in all studied parameters, but the endogenous thrombin potential (ETP) data showed complete discrepancy between the two methods. Lag time was the variable in which the samples were mostly abnormal in both assays. Lag time was prolonged in all samples using CAT and in 20 of 21 samples (95%) using ST Genesia (A). In terms of time to peak, all samples were abnormal using ST Genesia, while 19 of 21 (90%) were abnormal using CAT (B). Peak value was normal in one of 21 samples (5%; apixaban at 94 ng/mL) using ST Genesia and in 3 of 21 samples (14%) using CAT (C). Using ST Genesia, only 6 of 21 samples (29%) showed diminished ETP. In CAT, the ETP was abnormal in 19 of 21 samples (90%). Lines show the ST Genesia reference values reported in the literature 6 and the CAT in pooled normal plasma