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Anesth Analg 2007;104:59-64
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000248223.05152.a1

CARDIOVASCULAR ANESTHESIA

Qualitative Thrombelastographic Detection of Tissue Factor in Human Plasma

Vance G. Nielsen, MD*, Paul Audu, MD{dagger}, Lana Cankovic, MD*, Ralph T. Lyerly, III, MD*, Brad L. Steenwyk, MD*, Valerie Armstead, MD{dagger}, and Garry Powell, BS{dagger}

From the Department of *Anesthesiology, The University of Alabama at Birmingham, Birmingham, Alabama and Department of {dagger}Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania.

BACKGROUND: Tissue factor (TF) is the principal in vivo initiator of coagulation, with normal circulating TF concentrations reported to be approximately 23–158 pg/mL. However, patients with atherosclerosis or cancer have been reported to have TF concentrations ranging between 800 and 9000 pg/mL. Of interest, thrombelastographic (TEG®)-based measures of clot initiation and propagation have demonstrated hypercoagulability in such patients at risk for thromboembolic events. Thus, our goal in the present investigation was to establish a concentration-response relationship of the effect of TF on TEG® variables, and determine specificity of TF-mediated events with a monoclonal TF antibody.

METHODS: Thrombelastography was performed on normal human plasma exposed to 0, 500, 1000, or 2000 pg/mL TF. Additional experiments with plasma exposed to 0 or 750 pg/mL TF in the presence or absence of a monoclonal TF antibody (1:360 dilution, 10 min incubation) were also performed. Clot initiation time (R) and the speed of clot propagation (MRTG, maximum rate of thrombus generation) were determined.

RESULTS: The addition of TF to normal plasma resulted in a significant, concentration-dependent decrease in R and increase MRTG values. The addition of TF antibody to samples with TF significantly increased R and decreased MRTG values compared to samples with TF addition.

CONCLUSIONS: In conclusion, changes in TEG® variables in conjunction with use of a TF antibody can detect pathological concentrations of TF in human plasma in vitro. Further investigation is warranted to determine if TEG®-based monitoring could assist in the detection and prevention of TF-initiated thromboembolic events.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.