calibrated automated thrombogram

The calibrated automated thrombogram (CAT or CT) is a thrombin generation assay (TGA) and global coagulation assay (GCA) which can be used as a coagulation test to assess thrombotic risk.{{cite journal | vauthors = Hemker HC, Giesen P, AlDieri R, Regnault V, de Smed E, Wagenvoord R, Lecompte T, Béguin S | title = The calibrated automated thrombogram (CAT): a universal routine test for hyper- and hypocoagulability | journal = Pathophysiol Haemost Thromb | volume = 32 | issue = 5–6 | pages = 249–53 | date = 2002 | pmid = 13679651 | doi = 10.1159/000073575 | s2cid = 8378673 | url = | doi-access = }}{{cite journal | vauthors = Lim HY, Donnan G, Nandurkar H, Ho P | title = Global coagulation assays in hypercoagulable states | journal = J Thromb Thrombolysis | volume = 54| issue = 1| pages = 132–144| date = January 2022 | pmid = 34997471 | doi = 10.1007/s11239-021-02621-1 | s2cid = 245804095 | url = }} It is the most widely used TGA. The CAT is a semi-automated test performed in a 96-well plate and requires specialized technologists to be performed.{{cite journal | vauthors = Reda S, Morimont L, Douxfils J, Rühl H | title = Can We Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests? | journal = Hamostaseologie | volume = 40 | issue = 3 | pages = 364–378 | date = August 2020 | pmid = 32726831 | doi = 10.1055/a-1153-5824 | s2cid = 220878363 | url = | doi-access = free }} As a result, it has seen low implementation in routine laboratories and has been more limited to research settings.{{cite journal | vauthors = Lim HY, Leemaqz SY, Torkamani N, Grossmann M, Zajac JD, Nandurkar H, Ho P, Cheung AS | title = Global Coagulation Assays in Transgender Women on Oral and Transdermal Estradiol Therapy | journal = J Clin Endocrinol Metab | volume = 105 | issue = 7 | pages = e2369–e2377| date = July 2020 | pmid = 32413907 | doi = 10.1210/clinem/dgaa262 | s2cid = 218659931 | url = | doi-access = free }} Lack of standardization with the CAT has also led to difficulties in study-to-study comparisons in research. However, efforts have recently been made towards standardization of the assay.{{cite journal | vauthors = Douxfils J, Morimont L, Delvigne AS, Devel P, Masereel B, Haguet H, Bouvy C, Dogné JM | title = Validation and standardization of the ETP-based activated protein C resistance test for the clinical investigation of steroid contraceptives in women: an unmet clinical and regulatory need | journal = Clin Chem Lab Med | volume = 58 | issue = 2 | pages = 294–305 | date = January 2020 | pmid = 31444961 | doi = 10.1515/cclm-2019-0471 | s2cid = 201644826 | url = }}{{cite journal | vauthors = Morimont L, Bouvy C, Delvigne AS, Dogné JM, Douxfils J | title = Proof of concept of a new scale for the harmonization and the standardization of the ETP-based APC resistance | journal = J Thromb Haemost | volume = 18 | issue = 4 | pages = 895–904 | date = April 2020 | pmid = 31984653 | doi = 10.1111/jth.14745 | s2cid = 210922482 | url = | doi-access = free }}{{cite journal | vauthors = Morimont L, Didembourg M, Haguet H, Modaffari É, Tillier M, Bouvy C, Lebreton A, Dogné JM, Douxfils J | title = Interlaboratory variability of activated protein C resistance using the ETP-based APC resistance assay | journal = Res Pract Thromb Haemost | volume = 5 | issue = 7 | pages = e12612 | date = October 2021 | pmid = 34761157 | pmc = 8563922 | doi = 10.1002/rth2.12612 | url = }} An example of a specific commercial CAT is the Thrombinoscope by Thrombinoscope BV (now owned by Diagnostica Stago).{{cite journal | vauthors = Kintigh J, Monagle P, Ignjatovic V | title = A review of commercially available thrombin generation assays | journal = Res Pract Thromb Haemost | volume = 2 | issue = 1 | pages = 42–48 | date = January 2018 | pmid = 30046705 | pmc = 6055498 | doi = 10.1002/rth2.12048 | url = }}

The CAT can be used to measure thrombogram parameters such as the endogenous thrombin potential (ETP){{cite journal | vauthors = Duarte RC, Ferreira CN, Rios DR, Reis HJ, Carvalho MD | title = Thrombin generation assays for global evaluation of the hemostatic system: perspectives and limitations | journal = Rev Bras Hematol Hemoter | volume = 39 | issue = 3 | pages = 259–265 | date = 2017 | pmid = 28830606 | pmc = 5568585 | doi = 10.1016/j.bjhh.2017.03.009 | url = }} and to assess activated protein C resistance (APCR).{{cite journal | vauthors = Morimont L, Haguet H, Dogné JM, Gaspard U, Douxfils J | title = Combined Oral Contraceptives and Venous Thromboembolism: Review and Perspective to Mitigate the Risk | journal = Front Endocrinol (Lausanne) | volume = 12 | issue = | pages = 769187 | date = 2021 | pmid = 34956081 | pmc = 8697849 | doi = 10.3389/fendo.2021.769187 | url = | doi-access = free }} The CAT ETP-based APC resistance test is especially sensitive to estrogen-induced procoagulation, such as with combined oral contraceptives.{{cite journal | vauthors = Tchaikovski SN, Rosing J | title = Mechanisms of estrogen-induced venous thromboembolism | journal = Thromb Res | volume = 126 | issue = 1 | pages = 5–11 | date = July 2010 | pmid = 20163835 | doi = 10.1016/j.thromres.2010.01.045 | url = }}

In 2018, a commercial fully automated TGA system and alternative to the CAT called the ST Genesia debuted. It has been said that this system should allow for more widespread adoption of TGAs in clinical laboratories.{{cite journal | vauthors = Favaloro EJ, Lippi G | title = Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing | journal = Semin Thromb Hemost | volume = 45 | issue = 3 | pages = 228–246 | date = April 2019 | pmid = 30912101 | doi = 10.1055/s-0038-1676579 | s2cid = 85517668 | url = }} The ST Genesia system also shows improved reproducibility compared to the CAT.