Assessment of Clinical Hypercoagulability Tendency

E. von Kaulla, K.N. von Kaulla
1979 VIIth International Congress on Thrombosis and Haemostasis   unpublished
Optimal assessment of hypercoagulability which may result in various types of intravascular clotting requires the following procedures. No storage of blood specimens, analyzation right after withdrawal of blood (with few persons involved in work), blood obtained with siliconized, not plastic syringes. Use of citrate Na as anticoagulant by only 20 % dilution, further dilution increases but does not decrease coagulability. Hypercoagulability can be correctly assessed with the thrombin generation
more » ... hrombin generation test resulting in a curve leaving clotting factors in their natural relation and platelets in suspension. Synthetic substrates can be misleading. Some patients with a prothrombin time in therapeutic range have a normal thrombin generation showing that they are not protected. Short antithrombin III times reflect reduction of another protection against intravascular clotting. They must become prolonged by prothrombin-depressing agents, if not these agents are ineffective. Platelet aggregation induced by stirring only reveals another type of hypercoagulability tendency which cannot be treated with anticoagulants. Prolonged euglobulin lysis time reflects loss of yet another type of protection again, an intravascular clotting potential. Fast test for fibrin monomeres should be added. The tests mentioned revealed various types of hypercoagulability in most of the many patients who were referred to us for assessment of this tendency.
doi:10.1055/s-0039-1687209 fatcat:z2336kba4nd7xloo3g7k2o7o5y