TABLE 1.
Summaries of most relevant TGA studies performed to assess bleeding conditions. Thrombin is a strong contributor to clot formation. Therefore, it is considered that decreased TG is associated with an increased bleeding risk, provided that the system used for measuring TG is sensitive enough. Hemorrhagic diathesis develops once TG drops below 20% of normal 4
| Clinical situation | Preferred TGA parameter | Main findings | Reference | |
|---|---|---|---|---|
| Disease | Objective | |||
| Hemophilia A with inhibitors | Monitoring bypass therapy | Peak | TGA may be a useful tool to monitor bypassing agents | 6 |
| Hemophilia A | Personalized hemophilia prophylaxis | ETP | Increased frequency of spontaneous bleeding in severe hemophilia patients with reduced ETP, irrespective of factor VIII level. | 7, 8, 10 |
| Hemophilia A with inhibitors | Monitoring non‐factor therapy |
TGA may help physicians to determine the individual profile of patients receiving combined treatment with BPA and emicizumab, and to personalize bypassing therapy when treating breakthrough bleeds. |
7 | |
| Hemophilia A with inhibitors | Investigation of phenotypic heterogeneity of patients with FVIII inhibitors | ETP |
ETP could be a valuable marker in monitoring patients with FVIII inhibitors. |
12 |
| Hemophilia A with inhibitors | Surgery in patients with factor inhibitors | ETP |
TGT results correlate with the surgery related clinical bleeding risk and ETP may be used as a surrogate marker for monitoring bypassing agents. |
13 |
| Von Willebrand´s disease | Investigation of relationship between thrombin generation and bleeding tendency | Peak | A significant higher risk of bleeding was observed in patients with a low thrombin peak. | 14 |
| Acquired bleeding disorders | Factor inhibitors in non‐hemophiliac patients | ETP | Decreased thrombin generation capacity associated with the inhibition of thrombin generation of the normal control plasma after mixing with the patient's plasma samples suggested a probable risk of bleeding. | 15 |
| Cardiovascular disease | Prediction of bleeding in cardiac surgery | ETP | TGA performed preoperatively, provides information predictive for blood loss after cardiac surgery. | 17, 18 |