Comparative analysis

Comparative analysis of piezoelectric thromboelastograph ARP-01М «Mednord» (Russia) and thromboelastograph TEG 5000 (USA).

Instrumental Methods of the system regulating the aggregate state of blood play an important role in the arsenal of methods of investigation of the hemostatic system due to their reliability and validity, attract special attention of clinicians in connection with exceptional opportunities for rapid assessment of functional status and nature of the interaction of its component units, easy to perform research and its economy.

At the same time a vast majority of methods, despite their wide use in clinical practice, are marked with little informative base and low cost.

Thromboelastography, considered as “golden standard” among clinicians, regardless of the registration method, essentially determines four indicators: two chronometric (r, k) and two structural (МА, FА) ones, doesn’t ensure carrying out of dynamic control over the functional state of vascular-platelet, coagulatory and fibrinolytic links of the system. Besides, it’s necessary to note that a thromboelastograph needs expensive chemical reagents. This not only contributes to increase in the cost of the study itself, but also makes it impossible to compare the received results between hospitals using different reagents.

It is obvious that development of new research methods of the system regulating the aggregate state of blood is an urgent problem for clinical medicine.
Nowadays the company “Mednorth-Technics” has developed a hardware-software complex for clinical-diagnostic studies of blood rheological properties ARP-01M “Mednord” (piezoelectric thromboelastograph).

For convenience of comparison we will demonstrate the table of measured indicators:

Thromboelastograph TEG 5000

(USA)

Hardware-software Complex ARP-01М (Russia)
Whole blood Whole blood
R + r=t1 +
K + k=t2-t1 +
- ICC +
- CTA +
- TBC +
- ICD +
- ICP +
MA + МА +
- Т +
+ ICLR +
Citrated blood Citrated blood
Clotting methods + Clotting methods +

Table 1

As we may see from the above-stated table, thromboelastograph TEG 5000 produced in USA, when working with the whole blood, measures the following indicators:
•    r- time of contact coagulation;
•    k- main indicator characterizing the start time of clot formation;
•    МА- maximum clot density;
•    FА (ICLR) – intensity of clot retraction and lysis.

In its turn, the hardware-software complex ARP-01M “Mednord” ensures output of the following indicators as a graphical image to the computer screen:

Healthy patient

Figure 1


Patients with hypercoagulation and hypocoagulation


Figure 2

Denomination

Indicator

А0

- initial indicator of the blood aggregation state at he the moment of time t0

k=t2-t1

- time indicator of thrombin activity

r=t1

- time of a contact phase of coagulation, min

ICC

- intensity of a contact phase of coagulation

CTA

- constant of thrombin activity

TBC

- time of blood coagulation

ICD

- intensity of coagulation drive

ICP

- intensity of clot polymerization

МА

- maximum clot density

Т

- time of formation of fibrin-platelet clot structure, min

ICLR

- intensity of clot and lysis retraction

K – main indicator characterizing the start time of clot formation; depends on the concentration of the formed thrombin as well as antithrombin blood potential, concentration and functional full value of fibrinogen, factors of the pro-thrombin complex.
ICC – intensity of a contact phase of coagulation. The indicator characterizing intensity of CCCC- reaction of blood, pro-thrombin activity, aggregation activity of platelets and other blood cells.
CTA – constant of thrombin activity; characterizes the speed of thrombin-formation growth, intensity of the proteoclastic stage of clot formation.
TBC – time of blood coagulation.
ICD – intensity of coagulation drive – the indicator characterizing integrative influence of pro- and anti-coagulation systems on the process (speed) of clot formation.
ICP – intensity of clot polymerization – the indicator characterizing the speed of connection of monomer molecules “side-to-side”, “end-to-end”, forming the net of fibrin with peptide formula (?,?,?)n(F-P).
МА – the indicator reflecting the aggregate blood state at the final stabilizing stage of clot formation. It reflects the completion of hemostasis by formation of covalent bonds under the influence of XIII f.а., characterizes structural flow properties of the clot (viscosity, density, plasticity).
Т – time of F-T-S clot formation (constant of the total blood coagulation time).
ICLR – intensity of clot lysis and retraction. The indicator characterizing spontaneous clot lysis. It reflects intensity of the continuous process of hemocoagulation (CPH), the state of plasmin activity, quantity of cytogen structured into a clot, degree of liability of cytogen activators.

Method of BCPH with the use of the hardware-software complex for clinical-diagnostic studies of blood rheological properties ARP-01M “Mednord” as opposed to TEG 5000, which measures only a few indicators, is intended for complex evaluation of the state and functional interaction of all links of the hemostasis and fibrinolysis systems as well as for control over the effectiveness of purposeful therapy of hemostasis disorders. Besides, the possibility of real-time control over anti-coagulation therapy is an indisputable advantage of ARP-01M “Mednord”.

Moreover, the application of the hardware-software complex ARP-01M “Mednord” is economically reasonable, since the device is cheaper than the American TEG 5000 and doesn’t require the use of expensive chemical reagents for research. It is worth mentioning that, when using various chemical reagents, it is impossible to carry out comparative analysis of the received data. When working with ARP-01M “Mednord”, there appears no such problem and it is possible to carry out joint research and analysis between different hospitals and specialists.

The complex ARP-01M “Mednord” will allow to significantly increase the quality of diagnostics as well as prediction of development of cardio-vascular diseases, essentially reduce expenses of both federal and regional budgets on treatment of patients with cardio-vascular diseases (at the expense of prompt detection and correct therapy) and significantly reduce mortality rates.

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As we may see from the above-stated table, thromboelastograph TEG 5000 produced in USA, when working with the whole blood, measures the following indicators:

  • r- time of contact coagulation;
  • k- main indicator characterizing the start time of clot formation;
  • МА- maximum clot density;
  • FА (ICLR) - intensity of clot retraction and lysis.

In its turn, the hardware-software complex ARP-01M “Mednord” ensures output of the following indicators as a graphical image to the computer screen:

Figure 1 presents the chart of blood CPH (continuous process of hemocoagulation) of a healthy volunteer