Lab Med Online.  2021 Apr;11(2):106-114. 10.47429/lmo.2021.11.2.106.

Tissue Factor Pathway Inhibitor Levels and Thrombin Generation in Hemorrhagic Disease

• Lee S
• Song J

• KMID: 2525792
• DOI: http://doi.org/10.47429/lmo.2021.11.2.106

Abstract

Background
Tissue factor pathway inhibitor (TFPI) regulates blood coagulation. To treat hemorrhagic disease, studies have been conducted to achieve a hemostatic effect by inhibiting TFPI. In this study, blood TFPI levels of healthy and hemorrhagic disease groups were compared, and the effects of blood TFPI level and its activity on coagulation were investigated.
Methods
The blood TFPI levels of the healthy, chronic liver disease (CLD), chronic kidney disease (CKD), and hemophilia groups were measured and compared. Thrombin generation assay (TGA) was performed to investigate the effects of TFPI level and its activity on coagulation.
Results
The mean blood TFPI levels of the healthy, CLD, CKD, and hemophilia groups were 16.47 ng/mL, 24.90 ng/mL, 49.47 ng/mL, and 17.35 ng/mL, respectively. The healthy and CLD groups showed correlations between their blood TFPI levels and TGA parameters (P < 0.05). The TGA parameters of the CLD and hemophilia groups showed significant differences compared with those of the healthy group (P < 0.05). In FVIII-deficient plasma with anti-TFPI antibodies, the TGA parameters tended to be normalized according to anti-TFPI antibody levels. However, the differences in TGA parameters caused by FVIII concentration were unclear.
Conclusions
Although the TFPI level was related to bleeding in the disease groups, it is difficult to interpret its effects independently because of the various factors that affect the coagulation process. However, TFPI is worth studying to facilitate the development of a treatment strategy for bleeding due to lack of FVIII.

Keyword

Blood coagulation; Tissue factor pathway inhibitor; Thrombin generation assay; Anti-TFPI antibody

Figure

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  Fig. 1 Blood tissue factor pathway inhibitor (TFPI) levels in healthy, chronic kidney disease, chronic liver disease, and hemophilia groups.

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  Fig. 2 Thrombin generation assay (TGA) parameters of healthy (A, B, C, D), chronic liver disease (E, F, G, H), chronic kidney disease (I, J, K, L), and he­mophilia (M, N, O, P) groups.

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  Fig. 3 Comparison of thrombin generation assay (TGA) parameters between healthy and disease groups. (A) Lag time, (B) Endogenous thrombin potential (ETP), (C) Peak height, (D) Time to peak.

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  Fig. 4 Changes in thrombin generation assay (TGA) parameters of FVIII-deficient plasma according to anti-tissue factor pathway inhibitor (TFPI) antibody concentration. (A) Lag time, (B) Endogenous thrombin potential (ETP), (C) Peak height, (D) Time to peak.

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