Ann Lab Med.  2017 Nov;37(6):484-493. 10.3343/alm.2017.37.6.484.

Benefits of Thromboelastography and Thrombin Generation Assay for Bleeding Prediction in Patients With Thrombocytopenia or Hematologic Malignancies

• Kim SY
• Gu JY
• Yoo HJ
• Kim JE
• Jang S
• Choe S
• Koh Y
• Kim I
• Kim HK

• KMID: 2425988
• DOI: http://doi.org/10.3343/alm.2017.37.6.484

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.

Keyword

Thromboelastography; Thrombin generation assay; Bleeding risk; Platelet count; Hematologic malignancy

MeSH Terms

Area Under Curve
Blood Platelets
Hematologic Neoplasms*
Hemorrhage*
Humans
Plasma
Platelet Count
Thrombelastography*
Thrombin*
Thrombocytopenia*
World Health Organization
Thrombin

Figure

• 

  Fig. 1 Thromboelastography results of (A) reaction time (R), (B) coagulation time (K), and (C) maximum amplitude (MA) and (D) thrombin generation assay results of endogenous thrombin potential (ETP) with respect to WHO bleeding grade. P values are assessed by using Kruskal-Wallis analysis for the comparison of WHO bleeding grades. * for P<0.05 and ** for P<0.005 are indicated above each box; the P values were obtained from the comparison of patients with WHO bleeding grades of 1 or ≥2 with those with WHO bleeding grade of 0 using Mann-Whitney U test with Bonferroni correction for multiple testing.

• 

  Fig. 2 ROC curve and the area under the ROC curve (AUC) for (A) maximum amplitude (MA), (B) MA based on various platelet levels, (C) endogenous thrombin potential (ETP), (D) ETP based on platelet levels, (E) MA and ETP, and (F) MA and ETP based on platelet levels used to predict high bleeding tendency (WHO bleeding grade ≥2).

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