An evaluation of global coagulation assays in myeloproliferative neoplasm

Hui Y. Lim, Cheryl Ng, Joseph Rigano, Mark Alan Tacey, Geoffrey Donnan, Harshal Hanumant Nandurkar, Prahlad Wei Soon Ho

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.
LanguageEnglish
Pages300-306
Number of pages7
JournalBlood Coagulation and Fibrinolysis
Volume29
Issue number3
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • coagulation assays
  • essential thrombocythaemia
  • myeloproliferative neoplasm
  • polycythaemia vera
  • thromboelastography
  • thrombosis

Cite this

Lim, Hui Y. ; Ng, Cheryl ; Rigano, Joseph ; Tacey, Mark Alan ; Donnan, Geoffrey ; Nandurkar, Harshal Hanumant ; Ho, Prahlad Wei Soon. / An evaluation of global coagulation assays in myeloproliferative neoplasm. In: Blood Coagulation and Fibrinolysis. 2018 ; Vol. 29, No. 3. pp. 300-306.
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abstract = "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.",
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An evaluation of global coagulation assays in myeloproliferative neoplasm. / Lim, Hui Y.; Ng, Cheryl; Rigano, Joseph; Tacey, Mark Alan; Donnan, Geoffrey; Nandurkar, Harshal Hanumant; Ho, Prahlad Wei Soon.

In: Blood Coagulation and Fibrinolysis, Vol. 29, No. 3, 01.04.2018, p. 300-306.

Research output: Contribution to journalArticleResearchpeer-review

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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.

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