the creation of a whole-blood assay for measuring platelet activity. The new assay enables measurement of the platelet contribution to thrombin generation because it can evaluate platelet function during clotting. The test measures platelets at their highest level of activation because it is done with thrombin present. On a single 700 microL sample of citrated whole blood, three parameters are evaluated simultaneously. The force generated by platelets during clot retraction is directly measured as a function of time as platelet contractile force (PCF). This parameter is affected by antithrombin activities, glycoprotein IIb/IIIa status, platelet number, and platelet metabolic status.
The clot elastic modulus (CEM), which is also measured as a function of time, is sensitive to red blood cell flexibility, fibrinogen concentration, platelet concentration, rate of thrombin generation, and platelet force production. The PCF kinetics curve is used to determine the third parameter, the thrombin generation time (TGT). The initial increase in PCF happens at the time that thrombin is produced because PCF is completely thrombin dependent (no thrombin-no force). TGT is sensitive to clotting factor deficiency, clotting factor inhibitors, and antithrombin presence, all of which are known hemophilic states and prolong the TGT. The TGT toward normal is shortened when hemophilic states are treated with hemostatic drugs.
It has been shown that coronary artery disease, diabetes mellitus, and a number of other thrombophilic states result in shorter TGT and higher PCF. The TGT toward normal is prolonged when thrombophilic states are treated with a variety of heparin and nonheparin anticoagulants. The simultaneous measurement of PCF, CEM, and TGT may enable quick evaluation of global hemostasis and the response to various procoagulant and anticoagulant medications.
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