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Anticoagulated Patients Exhibit Intact Endogenous Thrombin Potential Using ST Genesia Unlike the Calibrated Automated Thrombogram

1Coagulation Disorders Unit, HUS Diagnostics Center, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland, 2Coagulation Disorders Unit, Helsinki University Hospital, Research Program Unit in Systems Oncology, University of Helsinki, Helsinki, Finland

Abstract Number: PB0370

Meeting: ISTH 2021 Congress

Theme: Diagnostics and OMICs » Laboratory Diagnostics

Background: The thrombin generation (TG) assay is a feasible but labor-intensive method for detecting global coagulation. It enables comprehensive assessment of anticoagulation, while drug-specific assays only assess exposure. Traditionally, the Calibrated Automated Thrombogram (CAT®) has been used, however the ST Genesia® (Diagnostica Stago) allows automated evaluation.

Aims: We aimed to observe coagulation using the ST Genesia® and compare the data with those of CAT® in anticoagulated patients.

Methods: Altogether, In total, 43 frozen-thawed samples were studied using DrugScreen® to assess direct oral anticoagulants (DOACs), warfarin, and low molecular-weight heparin. Twenty samples (nine rivaroxaban, five apixaban, three warfarin, and three heparin) were also compared using CAT® (5 pM tissue factor).

Results: TG reduction in DrugScreen® depended on the specific drug and modestly correlated with DOAC levels (lag time R2 = 0.36; peak R2 = 0.50, Figure). The best correlation was observed with Peak thrombin and rivaroxaban-specified anti-Xa activity (R2=0.60). When comparing ST Genesia® with CAT®, only the results for apixaban concorded (R2 = 0.97). Unlike CAT®, ST Genesia® yielded a normal endogenous thrombin potential (ETP) in 77% (24/31) FXa-inhibitor cases, and it failed to give readouts at INR ≥ 4.5 and at anti-Xa ≥ 1.0 IU/mL.

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.

Conclusions: The ST Genesia® data did not correlate with CAT®, but it was independently associated with INR, anti-Xa, and DOAC concentrations. The Lag time and Peak responses were similar; the major differences were that ST Genesia® showed no ETP effect of DOACs, and failed to give readout at high INR or anti-Xa activity.
These data have been accepted for publication in Research and Practice in Thrombosis and Haemostasis 23.1.2021.

To cite this abstract in AMA style:

Helin T, Lemponen M, Lassila R, Joutsi-Korhonen L. Anticoagulated Patients Exhibit Intact Endogenous Thrombin Potential Using ST Genesia Unlike the Calibrated Automated Thrombogram [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/anticoagulated-patients-exhibit-intact-endogenous-thrombin-potential-using-st-genesia-unlike-the-calibrated-automated-thrombogram/. Accessed September 24, 2023.

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