Influence of Blood Coagulation Factors on Thromboelastographic Parameters in Healthy Adults
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Background: Thromboelastography (TEG) is a method that assesses whole-blood coagulation efficiency by measuring different parameters of clot formation and clot lysis. Whether and how blood coagulation factors influence the TEG parameters is unknown. Methods: Blood coagulation factors measured by an automated coagulation analyzer (ACL TOP; Beckman Coulter, USA) and thrombin generation measured by automated thrombogram method (Thrombinoscope, Netherlands) were quantified in 109 healthy volunteers to investigate their correlation with six TEG parameters. TEG parameters were analyzed with the TEG 5000 Hemostasis Analyzer System (Haemonetics, USA). To assess whether TEG detects coagulation factor deficiencies, TEG was performed in four patients, with three known coagulation factor deficiencies. Results: Reaction time negatively correlated with factors V and XII, and clot formation time positively correlated only with factor XII. Alpha angle positively correlated with factor XII and negatively with protein S. Maximum amplitude showed a positive correlation with fibrinogen and factors VIII and XII, whereas coagulation index only with factors VIII and XII. Thrombin generation and percentage of fibrinolysis at 30 minutes after maximum amplitude exhibited no correlation with the TEG parameters. Of the four TEG-tested patients, only the patient with factor V deficiency had elevated reaction time values. Conclusions: TEG parameters, especially reaction time, are mainly affected by factors V and XII. Since TEG had limitations in detecting coagulation factor deficiencies, future research should improve its sensitivity with various stimuli that activate coagulation factors.
Abstract
Background: Thromboelastography (TEG) is a method that assesses whole-blood coagulation efficiency by measuring different parameters of clot formation and clot lysis. Whether and how blood coagulation factors influence the TEG parameters is unknown. Methods: Blood coagulation factors measured by an automated coagulation analyzer (ACL TOP; Beckman Coulter, USA) and thrombin generation measured by automated thrombogram method (Thrombinoscope, Netherlands) were quantified in 109 healthy volunteers to investigate their correlation with six TEG parameters. TEG parameters were analyzed with the TEG 5000 Hemostasis Analyzer System (Haemonetics, USA). To assess whether TEG detects coagulation factor deficiencies, TEG was performed in four patients, with three known coagulation factor deficiencies. Results: Reaction time negatively correlated with factors V and XII, and clot formation time positively correlated only with factor XII. Alpha angle positively correlated with factor XII and negatively with protein S. Maximum amplitude showed a positive correlation with fibrinogen and factors VIII and XII, whereas coagulation index only with factors VIII and XII. Thrombin generation and percentage of fibrinolysis at 30 minutes after maximum amplitude exhibited no correlation with the TEG parameters. Of the four TEG-tested patients, only the patient with factor V deficiency had elevated reaction time values. Conclusions: TEG parameters, especially reaction time, are mainly affected by factors V and XII. Since TEG had limitations in detecting coagulation factor deficiencies, future research should improve its sensitivity with various stimuli that activate coagulation factors.
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