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Global assays of hemostasis

Brummel-Ziedins, Kathleen E.; Wolberg, Alisa S.

doi: 10.1097/MOH.0000000000000074
HEMOSTASIS AND THROMBOSIS: Edited by Joseph E. Italiano and Jorge A. Di Paola

Purpose of review There exists an imbalance between our understanding of the physiology of the blood coagulation process and the translation of this understanding into useful assays for clinical application. As technology advances, the capabilities for merging the two areas have become more attainable. Global assays have advanced our understanding of the dynamics of the blood coagulation process beyond end point assays and are at the forefront of implementation in the clinic.

Recent findings We will review recent advances in the main global assays with a focus on thrombin generation that have potential for clinical utility. These assays include direct (thrombogram, whole blood, purified systems) and indirect empirical measures of thrombin generation (thromboelastography) and mechanism-based computational models that use plasma composition data from individuals to generate thrombin generation profiles.

Summary Empirical thrombin generation assays (direct and indirect) and computational modeling of thrombin generation have greatly advanced our understanding of the hemostatic balance. Implementation of these types of assays and visualization approaches in the clinic will potentially provide a basis for the development of individualized patient care. Advances in both empirical and computational global assays have made the goal of predicting precrisis changes in an individual's hemostatic state one step closer.

Department of Biochemistry, Colchester Research Facility, University of Vermont, Colchester, Vermont, USA

Correspondence to Dr Kathleen E. Brummel-Ziedins, Department of Biochemistry, Colchester Research Facility, University of Vermont, 208 S. Park Drive, Colchester, VT 05446, USA. Tel: +1 802 656 9599; fax: +1 802 656 2256; e-mail:

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