Is there a place for thrombin generation assay in routine clinical laboratory?]

Laboratory diagnosis of coagulopathies primarily relies on assays selectively exploring either the extrinsic (PT), the intrinsic (aPTT) or the common (TT) pathway of the coagulation system. Although these tests are very useful to rapidly identify severe coagulation disorders or to monitor anticoagulant therapy, they only poorly correlate with the clinical manifestations. Global assays that evaluate the whole coagulation process could potentially more accurately reflect the hemorrhagic or thrombotic phenotype of an individual. Thrombin generation assay (TGA), first described in the 1950' s, has been developed and automated in the 1990's. This technique is widely used in fundamental research but has yet failed to integrate clinical laboratories. In this article, we describe TGA and review its clinical applications. Laboratory aspects and technical issues will also be discussed.