Assessing Thrombin Generation at the Point of Care

Point-of-care testing (POCT)1 draws vitality from the invention of new biosensors and, in this issue of Clinical Chemistry , takes a major step forward with the introduction of an amperometric test strip that assesses thrombin generation (1). Historically, on-site whole-blood measurements, such as the activated coagulation time (2)(3) and ionized calcium, improved our understanding of the complex pathophysiology occurring during surgery and massive transfusion (4). Gaps have persisted, however, in our ability to decipher hemostasis events. Fortunately, we now have an opportunity to improve bedside decision-making. Potential applications include hemostatic treatment for hemophilias, inflammation and vascular remodeling, surgical microvascular bleeding, disseminated intravascular coagulation, thrombosis, drug therapy (e.g., hirudin and activated protein C), and severe sepsis, where previous insight into hyper- or hypocoagulable states has been difficult, if not impossible, with nonintegrative tests such as prothrombin time (PT) and activated partial thromboplastin time, and impractical with reagent- and labor-intensive thrombin assays requiring time-consuming processing steps and large sample volumes. Of course, we still must gain clinical experience with this new electrochemical thrombin biosensor and its benefits at the point of care (POC), whether hospital or home. Miniaturized technologies developed and implemented for use in handheld POC instruments …