J Thromb Haemost. 2026 Oct 3:S1538-7836(26)00627-6. doi: 10.1016/j.jtha.2026.09.037. Online ahead of print.
ABSTRACT
BACKGROUND: Venous thromboembolism (VTE) remains an important complication in critically ill adults despite standard pharmacological thromboprophylaxis. Thrombin generation assays (TGAs) offer a global functional assessment of coagulation by capturing the kinetics and magnitude of thrombin formation and may complement conventional measures of coagulation such as anti-Xa activity.
METHODS: The review was conducted according to JBI methodology and reported per PRISMA guidelines. We searched MEDLINE, Embase, and CENTRAL from inception to December 18, 2025. We included studies of adults (≥18 years) managed in high-acuity or intensive care settings with TGA measurements reported in relation to VTE incidence or thromboprophylaxis effect.
RESULTS: We included 15 eligible prospective studies comprising 2,250 patients (9 surgical trauma cohorts, 4 medical ICU cohorts, 2 mixed ICU cohorts). Calibrated automated thrombography (CAT) was the most used TGA platform (80.0%). Eleven studies (73.3%) evaluated associations between TGA and VTE incidence, with inconsistent findings. Some trauma cohorts identified shorter time-to-peak thrombin or lag time as predictors of VTE, while other studies found no significant associations. Of eight studies (53.3%) assessing TGA pharmacodynamics, seven measured anti-Xa activity, which correlated with lower endogenous thrombin potential and peak thrombin.
CONCLUSION: TGA most consistently served as a pharmacodynamic measure of low-molecular-weight heparin effect: anti-Xa activity correlated with suppressed endogenous thrombin potential and peak thrombin. TGA did not reliably predict VTE, though shorter time-to-peak and lag time preceded thrombosis in trauma cohorts. TGA should be advanced as a coagulation-phenotyping tool in prospective ICU studies with standardized assays, consistent sampling in relation to dose timing, and concurrent anti-Xa and thrombin generation measurement.
PMID:42829085 | DOI:10.1016/j.jtha.2026.09.037