Individual Therapy of Hemophilia — New Laboratory Methods Considering Platelets

Conclusions

The ETP is a global parameter that reflects the overall capacity of the coagulation system to generate thrombin. The clotting factors VIII and IX and platelets have a key influence on thrombin generation. Substitution with clotting factor concentrates enhance thrombin generation and this elevated thrombin generation can be measured by ETP. We can determine the point on which the ETP reaches an optimal level and further substitution does not improve the hemostatic potential. The problem is that this optimal level differs from patient to patient. But with our measurements we can identify this level and optimize the treatment of hemophilia patients. Because of the interaction between platelets and coagulation system we measure in platelet rich plasma. This method is also suitable to monitor alternative therapies in inhibitor patients like FEIBA or NovoSeven. For understanding the physiology of clotting not only the ETP but also other kinetic data such as the maximal thrombin peak or the begin of the thrombin generation should be considered.