TY - JOUR
T1 - An evaluation of global coagulation assays in myeloproliferative neoplasm
AU - Lim, Hui Y.
AU - Ng, Cheryl
AU - Rigano, Joseph
AU - Tacey, Mark Alan
AU - Donnan, Geoffrey
AU - Nandurkar, Harshal Hanumant
AU - Ho, Prahlad Wei Soon
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Myeloproliferative neoplasms (MPN) are independent risks for thrombotic events. Routine laboratory tests are inadequate to evaluate the underlying procoagulant state. Global coagulation assays such as thromboelastography, thrombin and fibrin generation may provide better assessment of coagulation activation and thereby of thrombosis risk. Participants with MPN were recruited. Thromboelastography was performed on citrated whole blood while thrombin generation using calibrated automated thrombogram, fibrin generation using overall haemostatic potential assays and P-selectin were quantified on plateletpoor plasma. Thirty-eight MPN patients (median age: 65 years) were recruited. There were 26 patients with essential thrombocythemia (68.4%), eight polycythemia vera (20.5%), three primary myelofibrosis and one MPN, unclassifiable. Compared with normal controls, there was no difference in
maximum amplitude although lysis time (LY30) was significantly higher (2.9 vs. 0.6%, adjusted P<0.01) using thromboelastography. Calibrated automated thrombogram showed higher thrombin peak (260.8 vs. 222.6nmol/l;
P<0.01) and velocity index (91.1 vs. 65.0nmol/l/min; P<0.01) with comparable endogenous thrombin potential. Fibrin generation parameters were significantly reduced with preserved overall fibrinolytic potential, whereas P-selectin
was markedly increased (108.9 vs. 49.3 ng/ml, P<0.01). This study demonstrated unique differences between MPN population and normal controls using a combination of global coagulation assays. The presence of high lysis time (LY30) and reduced fibrin generation in MPN patients were contradictory to the prothrombotic nature and may represent a compensatory effort to achieve equilibrium within the Virchow’s triad. Both markers may be important prognostic indicators of thrombosis in MPN and further prospective studies to confirmthese findings are proposed. Blood Coagul Fibrinolysis 29:300–306 Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved.
AB - Myeloproliferative neoplasms (MPN) are independent risks for thrombotic events. Routine laboratory tests are inadequate to evaluate the underlying procoagulant state. Global coagulation assays such as thromboelastography, thrombin and fibrin generation may provide better assessment of coagulation activation and thereby of thrombosis risk. Participants with MPN were recruited. Thromboelastography was performed on citrated whole blood while thrombin generation using calibrated automated thrombogram, fibrin generation using overall haemostatic potential assays and P-selectin were quantified on plateletpoor plasma. Thirty-eight MPN patients (median age: 65 years) were recruited. There were 26 patients with essential thrombocythemia (68.4%), eight polycythemia vera (20.5%), three primary myelofibrosis and one MPN, unclassifiable. Compared with normal controls, there was no difference in
maximum amplitude although lysis time (LY30) was significantly higher (2.9 vs. 0.6%, adjusted P<0.01) using thromboelastography. Calibrated automated thrombogram showed higher thrombin peak (260.8 vs. 222.6nmol/l;
P<0.01) and velocity index (91.1 vs. 65.0nmol/l/min; P<0.01) with comparable endogenous thrombin potential. Fibrin generation parameters were significantly reduced with preserved overall fibrinolytic potential, whereas P-selectin
was markedly increased (108.9 vs. 49.3 ng/ml, P<0.01). This study demonstrated unique differences between MPN population and normal controls using a combination of global coagulation assays. The presence of high lysis time (LY30) and reduced fibrin generation in MPN patients were contradictory to the prothrombotic nature and may represent a compensatory effort to achieve equilibrium within the Virchow’s triad. Both markers may be important prognostic indicators of thrombosis in MPN and further prospective studies to confirmthese findings are proposed. Blood Coagul Fibrinolysis 29:300–306 Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved.
KW - coagulation assays
KW - essential thrombocythaemia
KW - myeloproliferative neoplasm
KW - polycythaemia vera
KW - thromboelastography
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85046788580&partnerID=8YFLogxK
U2 - 10.1097/MBC.0000000000000724
DO - 10.1097/MBC.0000000000000724
M3 - Article
C2 - 29538005
AN - SCOPUS:85046788580
VL - 29
SP - 300
EP - 306
JO - Blood Coagulation & Fibrinolysis
JF - Blood Coagulation & Fibrinolysis
SN - 0957-5235
IS - 3
ER -