Background: Thrombin burst has attracted many attentions as a physiological coagulation mechanism. However, the clinical evidence for it is scarce in routine methods.

Aims: The mechanism of thrombin burst was evaluated by a clot waveform analysis (CWA) to assess the thrombin time (TT).

Methods: The TT with a low concentration of thrombin (0.01~5.0 IU/ml) was evaluated using a CWA on ACL-TOP system. We evaluated the CWA-TT of plasma deficient for various clotting factors, calibration plasma, platelet-poor plasma (PPP) and platelet-rich plasma (PRP) obtained from healthy volunteers, patients with thrombocytopenia and patients with malignant disease.

Results: Although the TT-CWA of calibration plasma was able to be evaluated with 0.01 IU/ml of thrombin, that of FVIII-deficient plasma could not be evaluated. The peak time of CWA-TT was significantly longer and the peak height significantly lower in various deficient plasma, especially FVIII-deficient plasma than in calibration plasma. The second peak of the first derivative (1st DP-2) was detected in PPP from healthy volunteers and was shorter and higher in PRP than in PPP. The 1st DP-2 was not detected in PPP from patients with thrombocytopenia, and the 1st DP-2 in PRP was significantly lower in patients with thrombocytopenia and significantly higher in patients with malignant disease than in healthy volunteers.

Conclusion(s): The CWA-TT became abnormal in plasma deficient for various clotting factors and was significantly affected by platelet number, suggesting that the CWA-TT may be a useful test for thrombin burst or hemostatic abnormalities.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/evaluation-of-thrombin-burst-using-thrombin-time-of-clot-waveform-analysis/