docPrimary Haemostasis Haemostasis activation Thrombosis
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Primary Haemostasis Haemostasis activation Thrombosis
Innovation dedicated to Haemostasis Following platelet activation and plasmatic coagulation, new molecules appear circulating in the plasma and the platelet membrane proteins are modified. An increase of these markers can reveal a prothrombotic state. HAE tPA MO ST Plasminogen D D Plasmin Fibrin IS AT D E D A TXA2 + RE GG GA IIa IIa Fibrin Nitric oxide Prostacyclin APC PS II IIa V AP C TFPI TFPI Xa vWF PAR1 PLM T αA Insoluble Fibrin II VKA V + FPA + FPB AT Fibrinogen Va PLM Heparins Anti-IIa VWF IXa VIIIa XD αAP Activated Platelet AT XI YY Xa X XIIIa DY VIII XY XIII DXD Fibrinogen Degradation Products YXD Fragment D XX Fragment Y YXY VIII XXD IX Xa TFPI IIa X XIa Anti-Xa IX Fragment E IIa VIIa VII TF VIIa VII TF T IXa VIIIa APC PS II XI FPA DD G VWF IXa VIIIa APC PS XIa Activated Platelet Soluble Fibrin PLG AT XI T Xa Fibrin Monomer αM Activated Platelet X anti-Xa Heparan sulphate A Va A VIII VWF VIII V a X XIa a Released molecules* Va TAFIa Specific anti-IIa and anti-Xa drugs (tc-uPA) Fibrin Degradation Products AT C AT T PS sGPVf1 Activated platelet AP Lys Lys IIa XIIa UK PAI-1 II PS HMWK C1inh A Fibrinogen IIa TAFI IIa V AT Microparticles + P2Y1 anti-IIa PC IIa GMP140 or P selectin HC II K PK tc-tP A Fibrinogen Historical Multi target Anticoagulants ProUK (sc-uPA) Fibrinogen Dermatan sulphate N TIO GPIb/ Vf2/IX The parameters: IX A T The parameters: X •Von Willebrand Factor •Fibrinogen V IIa TF n AT Heparan sulphate + ADP IIa IIa PA TM T + + Fibrin IIa A TXA P2Y12 Fibrin sc-t •D-Dimer Inhibition pathways Activation pathways Coagulation Fibrinolysis Xa TFPI VIIa AT AT PAI-1 APC PS The parameters: The parameters: •Antithrombin •D-Dimer •INR for VKA monitoring •Protein C •Anti-Xa activity direct(rivaroxaban, apixaban, edoxaban) and indirect (heparins, fondaparinux…) Xa inhibitors determination TFPI •Von Willebrand Factor •Activated Protein C Resistance •Fibrin and Fibrinogen Degradation Products •ß-Thromboglobulin •Fibrin Monomers •Protein S •Soluble Fibrin Monomer Complexes •Soluble Glycoprotein V (sGPV) •Soluble Fibrin Monomer Complexes •C4b-BP •Fibrin Monomers •Platelet Glycoproteins by Flow Cytometry •Platelet Factor 4 •Protein Z •Plasminogen •Heparin Cofactor II (HCII) •tPA (Tissue Plasminogen Activator) •Anti-platelet antibodies by Flow Cytometry •ß-Thromboglobulin •Soluble Glycoprotein V (sGPV) •Inhibitor of the Extrinsic Pathway (TFPI) •Antiplasmin •Soluble Endothelial Protein C Receptor (sEPCR) •Soluble Endothelial Protein C Receptor (sEPCR) •Plasminogen Activator Inhibitor (PAI) •Monitoring of P2Y12 ADP receptor antagonists (clopidogrel, prasugrel, ticagrelor, cangrelor…) •Platelet Glycoproteins by Flow Cytometry •Lupus Anticoagulants •Thrombin Activatable Fibrinolysis Inhibitor (TAFI) •Monitoring of GpIIb/IIIa antagonists by Flow Cytometry •Antiphospholipid Antibodies •Microparticles •Thrombin Generation •Thrombin Generation •Coagulant Activity Monitoring for Activated Factor VII •Microparticles •Microparticles •Platelet Factor 4 •Thrombin Generation •Microparticles Therapeutic inhibitor Physiological inhibitor TF •Coagulation factors Xa The parameters: •Activated Factor VII - Antithrombin complex •Anti-IIa activity for Direct Thrombin Inhibitors determination (dabigatran, argatroban, bivalirudin) •Clotting assay for monitoring Factors VIII and IX •Anti-heparin/PF4 antibodies detection •Thrombin Generation At the Heart of Haemostasis 4614© 2006 DIAGNOSTICA STAGO - All rights reserved - Non-contractual pictures - 04/2013. Ref. 27854 GPIIb/IIIa HC II Haemostasis disorders can be regulated by a broad panel of anti-thrombotic or antihaemorrhagic treatments. Many assays are available to measure the activity of these molecules. HC II PLM TM Fibrinogen + IIa AT PAI1 E ADP Fibrinolysis is the enzymatic process which, along with vascular repair, leads to the destruction of the clot to restore normal blood circulation. An imbalance of the stability in anti-fibrinolytic factors results in a Haemostasis disorder. AT D E Thienopyridines The onset of plasma coagulation is an «explosive» event that triggers the generation of thrombin. Various control pathways involving a number of different inhibitors regulate thrombin generation and ensure that homeostasis is maintained. Anomalies regarding these inhibitors are the chief cause of venous and/or arterial thrombosis. However, thrombosis may also result from the presence of antiphospholipid antibodies. P D Anti GPIIb/IIIa Fibrinolysis Physiological anti-IIa and anti-Xa A I-1 FDP D-Dimer AS Thrombosis AT The primary Haemostasis corresponds to the reactions occurring after vascular damage and leads to the formation of a stable platelet clot. This is the first stage of the Haemostasis. To be effective, primary Haemostasis requires the optimal function of Von Willebrand Factor and platelets. Therapeutic monitoring T Haemostasis activation A Primary Haemostasis Diagnostica Stago S.A.S. RCS Nanterre B305 151 409 9, rue des Frères Chausson 92600 Asnières sur Seine (France) Ph.: +33 (0)1 46 88 20 20 Fax: +33 (0)1 47 91 08 91 [email protected] www.stago.com
