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Coagulation status of critically ill patients with and without liver disease assessed using a novel thrombin generation analyzer.

Morrow, Gael B.; Beavis, James; Harper, Sarah; Baker, Peter; Desborough, Michael J.R.; Stanworth, Simon J.; Laffan, Mike A.; Curry, Nicola


James Beavis

Sarah Harper

Peter Baker

Michael J.R. Desborough

Simon J. Stanworth

Mike A. Laffan

Nicola Curry


The liver synthesizes the majority of pro- and anti-oagulant and fibrinolytic proteins, and during liver dysfunction synthesis of these proteins is reduced. The end point of conventional hemostatic tests, such as the prothrombin time (PT), occurs when only 5% of thrombin generation (TG) has taken place and is not sensitive to the effects of natural anti-coagulants. The aim of this study was to determine whether TG in the presence of thrombomodulin (TM) provides more useful information about coagulation potential, in comparison to the PT. Analysis was performed on ST Genesia, a novel TG analyzer from Diagnostica Stago. TG was measured using STG-Thromboscreen, a reagent containing an intermediate concentration of human tissue factor (TF) ± rabbit TM to account for anti‐coagulant protein C (PC) activity. Platelet-poor plasma (PPP) samples were from the Intensive Care Study of Coagulopathy-2 (ISOC-2), which recruited patients admitted to critical care with a prolonged PT (3 seconds above the reference range). Despite a prolonged PT, 48.0% and 60.7% of patients in the liver and non-liver groups had TG parameters within the normal range. Addition of TM reduced TG by 34.5% and 41.8% in the liver and non-liver groups, respectively. Interestingly, fresh frozen plasma (FFP) transfusion had no impact on TG. Measurement of TG with addition of TM provides a more informative assessment of coagulation capacity and indicates that hemostasis is balanced in patients with liver disease during critical illness, despite conventional tests suggesting that bleeding risk is increased.


MORROW, G.B., BEAVIS, J., HARPER, S., BAKER, P., DESBOROUGH, M.J.R., CURRY, N., STANWORTH, S.J. and LAFFAN, M.A. 2020. Coagulation status of critically ill patients with and without liver disease assessed using a novel thrombin generation analyzer. Journal of thrombosis and haemostasis [online], 18(7), pages 1576-1585. Available from:

Journal Article Type Article
Acceptance Date Mar 16, 2020
Online Publication Date Jul 3, 2020
Publication Date Jul 31, 2020
Deposit Date Aug 7, 2023
Publicly Available Date Aug 15, 2023
Journal Journal of thrombosis and haemostasis
Print ISSN 1538-7933
Electronic ISSN 1538-7836
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 18
Issue 7
Pages 1576-1585
Keywords Critically ill; Liver disease; Thrombin; Thrombomodulin; Transfusion
Public URL


MORROW 2020 Coagulation status of critically (VOR) (7.8 Mb)

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Copyright Statement
© 2020 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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