Benefits of Thromboelastography and Thrombin Generation Assay for Bleeding Prediction in Patients With Thrombocytopenia or Hematologic Malignancies.
10.3343/alm.2017.37.6.484
- Author:
Seon Young KIM
1
;
Ja Yoon GU
;
Hyun Ju YOO
;
Ji Eun KIM
;
Seonpyo JANG
;
Sooyeon CHOE
;
Youngil KOH
;
Inho KIM
;
Hyun Kyung KIM
Author Information
1. Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. lukekhk@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Thromboelastography;
Thrombin generation assay;
Bleeding risk;
Platelet count;
Hematologic malignancy
- MeSH:
Area Under Curve;
Blood Platelets;
Hematologic Neoplasms*;
Hemorrhage*;
Humans;
Plasma;
Platelet Count;
Thrombelastography*;
Thrombin*;
Thrombocytopenia*;
World Health Organization
- From:Annals of Laboratory Medicine
2017;37(6):484-493
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Thromboelastography (TEG) provides comprehensive information on the whole blood clot formation phases, whereas thrombin generation assay (TGA) reveals the endogenous thrombin levels in plasma. We investigated the potential significance of TEG and TGA parameters for prediction of clinical bleeding in hematologic patients on the basis of the patient's platelet levels. METHODS: TEG and TGA were performed in 126 patients with thrombocytopenia or hematologic malignancies. The bleeding tendencies were stratified on the basis of the World Health Organization bleeding grade. RESULTS: Maximum amplitude (MA) and clot formation in TEG and endogenous thrombin potential (ETP) in TGA showed significant associations with high bleeding grades (P=0.001 and P=0.011, respectively). In patients with platelet counts ≤10×10⁹/L, low MA values were strongly associated with a high bleeding risk. For bleeding prediction, the area under the curve (AUC) of MA (0.857) and ETP (0.809) in patients with severe thrombocytopenia tended to be higher than that of platelets (0.740) in all patients. Patients with platelet counts ≤10×10⁹/L displayed the highest AUC of the combined MA and ETP (0.929). CONCLUSIONS: Both TEG and TGA were considered to be good predictors of clinical bleeding in patients with severe thrombocytopenia. Combination of the ETP and MA values resulted in a more sensitive bleeding risk prediction in those with severe thrombocytopenia.