Analysis of hyperfibrinolysis detection with ClotPro’s

ECA-test
2023
I. Zátroch1, E. Dinya2, J. Fazakas3
1Uzsoki Hospital, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary,
2Semmelweis University, Institute of Digital Health Sciences, Budapest, Hungary,
3Semmelweis University, Department of Surgery, Transplantation and Interventional Gastroenterology and Department of Anesthesiology and

Intensive Therapy, Budapest, Hungary

Introduction
Liver diseases lead to a re-balanced state in the hemostasis. Besides, hyperfibrinolysis is commonly seen during liver transplants due to the
absence of tPA-clearance. Our earlier results showed that fibrinolysis could be detected in more patients and earlier with ECA-test when
compared to IN-test and EX-test on ClotPro1. Our presumption was that this could be attributed to the absence of calcium in the ECA-test,
resulting in the lack of activation of FXIII and TAFI. On the other hand, thrombin generation is crutial in the formation of the fibrin mesh.
The aim of the further analysis of our previous results was to assess if the kinetics of TF and ecarin-activated thrombin generation show any
difference when compared to the elagic acid-induced thrombin generation, and if this could contribute to distinct sensitivity to fibrinolysis of
the ECA-test.

Methods
From 25 adult liver transplant (OLTx) recipients systemic blood samples were collected in 5 pre-defined time-points (S1-5) during surgery.
Viscoelastic hemostatic assays with ClotPro’s IN-test, EX-test, and ECA-test were performed simultaneously from each blood sample.
Hyperfibrinolysis was defined on the basis of the manufacturer’s pre-specified threshold value (maximal lysis >15%).

S1 S2 S3 S4 S5
Before OLTx Hepatectomy Anhepatic phase Neohepatic phase End of OLTx

The maximal velocity (MaxV) of thrombin generation and the

area under the curve (AUC), indicative of the total amount of MaxV
generated thrombin, were calculated from the first derivate of the
viscoelastic curve2. Independent samples t-test, Kruskal-Wallis AUC
test and Bonferroni correction were used to compare these
parameters between EX-test vs ECA-test and IN-test vs ECA-test
in lysis and non-lysis groups.

Results
EX-test IN-test ECA-test Thrombingeneration parameters in the no lysis
n 124 124 124 and lysis grup
all MaxV 49,7 ± 20,9 41,1 ± 20,1 43,6 ± 16 100
AUC 15 ± 2,7 13,9 ± 3,3 15,5 ± 3 90
no lysis
80
n 106 110 98 lysis
70
no lysis MaxV 51,5 ± 21,3 42,5 ± 20,5 46,4 ± 15,2 60
AUC 15,3 ± 2,6 14,2 ± 3,2 16,3 ± 2,2 50
40
n 18 14 26
30
lysis MaxV 39,3 ± 15,1 31,7 ± 15,7 34,3 ± 14,7 20
AUC 13,2 ± 2,7 11,8 ± 3,4 12,4 ± 3,2 10
0
EX_MaxV IN_MaxV ECA_MaxV EX_AUC IN_AUC ECA_AUC

A total of 125 tests were performed. The AUC value was significantly lower in the lysis groups of all tests (EX-test p=0.02; IN-test p=0.009;
ECA-test p=0.001). However, no statistically significant difference could be detected in terms of MaxV and in AUC when thrombin generation
capability was assessed within the groups with hyperfibrinolysis (MaxV EX vs ECA p=0.774; IN vs ECA p=0.105; AUC EX vs ECA and IN vs
ECA p=1).

Discussion
Within the groups showing hyperfibrinolysis, no significant difference could be detected between respective ClotPro tests in terms of thrombin
generation velocity (MaxV) and in the amount of generated thrombin (AUC). These results failed to indicate altered thrombin generation in the
ecarin-induced test, which infers that distinct sensitivity to fibrinolysis of the ECA-test cannot be attributed to features of thrombin generation.

References
1Zátroch, I., Dinya, E. & Fazakas, J. New under the sun: ClotPro's ECA-test detects hyperfibrinolysis in a higher number of patients, more frequently and 9 min earlier. Blood
Coagul Fibrinolysis 34, 99-104 (2023). https://doi.org:10.1097/MBC.0000000000001185
2Sørensen, B., Johansen, P., Christiansen, K., Woelke, M. & Ingerslev, J. Whole blood coagulation thrombelastographic profiles employing minimal tissue factor activation. J
Thromb Haemost 1, 551-558 (2003). https://doi.org:10.1046/j.1538-7836.2003.00075.x