Calibrated automated thrombogram

The calibrated automated thrombogram (CAT or CT) is a thrombin generation assay (TGA) and global coagulation assay (GCA) which can be used as a coagulation test to assess thrombotic risk.[1][2] It is the most widely used TGA.[3] The CAT is a semi-automated test performed in a 96-well plate and requires specialized technologists to be performed.[3] As a result, it has seen low implementation in routine laboratories and has been more limited to research settings.[3][4] Lack of standardization with the CAT has also led to difficulties in study-to-study comparisons in research.[3][5] However, efforts have recently been made towards standardization of the assay.[5][6][7][8] An example of a specific commercial CAT is the Thrombinoscope by Thrombinoscope BV (now owned by Diagnostica Stago).[9]

The CAT can be used to measure thrombogram parameters such as the endogenous thrombin potential (ETP)[2][10] and to assess activated protein C resistance (APCR).[5] The CAT ETP-based APC resistance test is especially sensitive to estrogen-induced procoagulation, such as with combined oral contraceptives.[2][5][11]

In 2018, a commercial fully-automated TGA system and alternative to the CAT called the ST Genesia debuted.[3] It has been said that this system should allow for more widespread adoption of TGAs in clinical laboratories.[3][12] The ST Genesia system also shows improved reproducibility compared to the CAT.[3]

References
  1. Hemker HC, Giesen P, AlDieri R, Regnault V, de Smed E, Wagenvoord R, Lecompte T, Béguin S (2002). "The calibrated automated thrombogram (CAT): a universal routine test for hyper- and hypocoagulability". Pathophysiol Haemost Thromb. 32 (5–6): 249–53. doi:10.1159/000073575. PMID 13679651. S2CID 8378673.
  2. Lim HY, Donnan G, Nandurkar H, Ho P (January 2022). "Global coagulation assays in hypercoagulable states". J Thromb Thrombolysis. doi:10.1007/s11239-021-02621-1. PMID 34997471. S2CID 245804095.
  3. Reda S, Morimont L, Douxfils J, Rühl H (August 2020). "Can We Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests?". Hamostaseologie. 40 (3): 364–378. doi:10.1055/a-1153-5824. PMID 32726831. S2CID 220878363.
  4. Lim HY, Leemaqz SY, Torkamani N, Grossmann M, Zajac JD, Nandurkar H, Ho P, Cheung AS (July 2020). "Global Coagulation Assays in Transgender Women on Oral and Transdermal Estradiol Therapy". J Clin Endocrinol Metab. 105 (7): e2369–e2377. doi:10.1210/clinem/dgaa262. PMID 32413907. S2CID 218659931.
  5. Morimont L, Haguet H, Dogné JM, Gaspard U, Douxfils J (2021). "Combined Oral Contraceptives and Venous Thromboembolism: Review and Perspective to Mitigate the Risk". Front Endocrinol (Lausanne). 12: 769187. doi:10.3389/fendo.2021.769187. PMC 8697849. PMID 34956081.
  6. Douxfils J, Morimont L, Delvigne AS, Devel P, Masereel B, Haguet H, Bouvy C, Dogné JM (January 2020). "Validation and standardization of the ETP-based activated protein C resistance test for the clinical investigation of steroid contraceptives in women: an unmet clinical and regulatory need". Clin Chem Lab Med. 58 (2): 294–305. doi:10.1515/cclm-2019-0471. PMID 31444961. S2CID 201644826.
  7. Morimont L, Bouvy C, Delvigne AS, Dogné JM, Douxfils J (April 2020). "Proof of concept of a new scale for the harmonization and the standardization of the ETP-based APC resistance". J Thromb Haemost. 18 (4): 895–904. doi:10.1111/jth.14745. PMID 31984653. S2CID 210922482.
  8. Morimont L, Didembourg M, Haguet H, Modaffari É, Tillier M, Bouvy C, Lebreton A, Dogné JM, Douxfils J (October 2021). "Interlaboratory variability of activated protein C resistance using the ETP-based APC resistance assay". Res Pract Thromb Haemost. 5 (7): e12612. doi:10.1002/rth2.12612. PMC 8563922. PMID 34761157.
  9. Kintigh J, Monagle P, Ignjatovic V (January 2018). "A review of commercially available thrombin generation assays". Res Pract Thromb Haemost. 2 (1): 42–48. doi:10.1002/rth2.12048. PMC 6055498. PMID 30046705.
  10. Duarte RC, Ferreira CN, Rios DR, Reis HJ, Carvalho MD (2017). "Thrombin generation assays for global evaluation of the hemostatic system: perspectives and limitations". Rev Bras Hematol Hemoter. 39 (3): 259–265. doi:10.1016/j.bjhh.2017.03.009. PMC 5568585. PMID 28830606.
  11. Tchaikovski SN, Rosing J (July 2010). "Mechanisms of estrogen-induced venous thromboembolism". Thromb Res. 126 (1): 5–11. doi:10.1016/j.thromres.2010.01.045. PMID 20163835.
  12. Favaloro EJ, Lippi G (April 2019). "Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing". Semin Thromb Hemost. 45 (3): 228–246. doi:10.1055/s-0038-1676579. PMID 30912101. S2CID 85517668.


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