[Thrombinography: towards a globalization of coagulation tests].

Thrombin is the key enzyme of coagulation and thrombin generation is the central haemostatic process. Current clotting tests (PT, aPTT) measure the time at which the first fibrin filaments appear after activation of coagulation. Yet, more than 95% of thrombin is generated after clot detection, which underlies the poor sensitivity of usual clotting tests for the detection of many hemorrhagic or thrombotic diseases. Thrombinography measures the kinetics of thrombin generation and inactivation during ex vivo coagulation, in standardized conditions. Thrombin generation is reduced in hemophiliacs and in patients under anticoagulant treatment. Thrombin activity is raised in hypercoagulable states, such as antithrombin deficiency, protein C and S deficiency, factor V Leiden and in women under oral contraceptives. Thrombin generation is delayed but amplified in the presence of lupus anticoagulants. In platelet-rich plasma, thrombin generation detects thrombopathies and von Willebrand disease, and allows monitoring of antiplatelet drugs. Thrombinography allows for a global phenotype of the thrombosis-hemostasis system.