Newer avenues in the monitoring of antithrombotic therapy: the role of automation.

In the future, we may find that antithrombotic therapy provides its major effects other than by Factors Xa and IIa inhibition, in which case a panel of assays may be of clinical use to determine how a given patient is responding to therapy. All methods discussed previously for direct factor assays, global tests, or specific factor inhibition can be modified for synthetic substrates. With instruments such as the IL Multistat III centrifugal analyzer, which has detection capabilities for visible light, fluorescence and light scatter, it will be possible to panel profile synthetic substrate-based assays, immunologic assays (for example, platelet release products or circulating complexes of enzyme-inhibitor, such as thrombin-AT III) and possibly platelet aggregations/luminescence in one rotor. The field of coagulation is rapidly expanding in the development of newer tests to measure newly discovered proteins (protein C), development of new drugs and therapeutic regimens, and incorporating immunologic and enzymologic technologies and clinical chemistry standardization and quality control practices. Throughout this period of growth, automation has been in the forefront and is playing an ever-increasing role in every old and new aspect of coagulation evaluation. We are aware of the advantages that accompany any automated device over manual techniques, so there should be much hope and expectation for the new hemostasis and thrombosis laboratory.