Abstract
Objectives
No consensus exists upon whether arterial and venous blood samples are equivalent when it comes to coagulation analyses. We therefore conducted a comparative cohort study to clarify if arteriovenous differences affect analyses of primary and secondary hemostasis as well as fibrinolysis.
Methods
Simultaneous paired blood samplings were obtained from a cannula in the radial artery and an antecubital venipuncture in 100 patients immediately before or one day after thoracic surgery. Analyses of platelet count and aggregation, International Normalized Ratio (INR), activated partial thromboplastin time (APTT), antithrombin, thrombin time, fibrinogen, D-dimer, rotational thromboelastometry (ROTEM), thrombin generation, prothrombin fragment 1 + 2, and an in-house dynamic fibrin clot formation and lysis assay were performed.
Results
No differences were found between arterial and venous samples for the far majority of parameters. The only differences were found in INR, median (IQR): venous, 1.1 (0.2) vs. arterial, 1.1 (0.2) (p<0.002) and in prothrombin fragment 1 + 2: venous, 289 (209) pmol/L vs. arterial, 279 (191) pmol/L (p<0.002).
Conclusions
The sampling site does not affect the majority of coagulation analyses. Small differences were found for two parameters. Due to numerically very discrete differences, they are of no clinical relevance. In conclusion, the present data suggest that both samples obtained from arterial and venous blood may be applied for analyses of coagulation and fibrinolysis.
Acknowledgments
The authors wish to thank Mikkel H. Christensen for invaluable support with R Studio as well as Mai Stenulm Veirup and Vivi Bo Mogensen for their effort in the laboratory.
-
Research funding: Internal funds from Department of Clinical Biochemistry, Aarhus University Hospital, Denmark
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Oral consent was obtained according to Danish health law from all individuals included in this study.
-
Ethical approval: The Central Denmark Region Ethics Committee on Biomedical Research deemed the study exempt from review. The study was approved by the hospital direction at Aarhus University Hospital, Denmark.
References
1. Naimi, S, Goldstein, R, Proger, S. Studies of coagulation and fibrinolysis of the arterial and venous blood in normal subjects and patients with atherosclerosis. Circulation 1963;27:904–18. https://doi.org/10.1161/01.cir.27.5.904.Search in Google Scholar
2. Ozsoylu, S. The comparison of the coagulation factors in arterial and venous blood. Acta Haematol 1969;41:303–8. https://doi.org/10.1159/000208865.Search in Google Scholar
3. Saveleva, TV, Kuznik, BI, Goldentsvaig, YD. Coagulability of arterial and venous blood in healthy subjects, patients with coronary atherosclerosis, and patients with rheumatic cardiopathies. Cor Vasa 1976;18:249–57.Search in Google Scholar
4. Aviram, M, Viener, A, Brook, JG. Reduced plasma high-density lipoprotein and increased platelet activity in arterial versus venous blood. Postgrad Med 1987;63:91–4. https://doi.org/10.1136/pgmj.63.736.91.Search in Google Scholar
5. Mundal, HH, Nordby, G, Lande, K, Gjesdal, K, Kjeldsen, SE, Os, I. Effect of cold pressor test and awareness of hypertension on platelet function in normotensive and hypertensive women. Scand J Clin Lab Invest 1993;53:585–91. https://doi.org/10.3109/00365519309092557.Search in Google Scholar
6. Haynes, SR, Allardyce, W, Cowan, B, Tansey, P. Accuracy of coagulation studies performed on blood samples obtained from arterial cannulae. Br J Anaesth 1992;69:599–601. https://doi.org/10.1093/bja/69.6.599.Search in Google Scholar
7. Blann, AD, Adams, RA, Katai, F, Ashleigh, R, Taberner, DA. Haematology and coagulation indices in paired samples of arterial and venous blood from patients with arterial disease. Haemostasis 1996;26:72–8. https://doi.org/10.1159/000217190.Search in Google Scholar
8. Heap, MJ, Ridley, SA, Hodson, K, Martos, FJ. Are coagulation studies on blood sampled from arterial lines valid? Anaesthesia 1997;52:640–5. https://doi.org/10.1111/j.1365-2044.1997.148-az0152.x.Search in Google Scholar
9. Rubens, FD, Labow, RS, Waghray, G, Robblee, J. The importance of sampling site in the measurement of whole-blood platelet flow cytometry. J Cardiothorac Vasc Anesth 1998;12:309–13. https://doi.org/10.1016/s1053-0770(98)90012-x.Search in Google Scholar
10. Li-Saw-Hee, FL, Blann, AD, Goldsmith, I, Lip, GY. Indexes of hypercoagulability measured in peripheral blood reflect levels in intracardiac blood in patients with atrial fibrillation secondary to mitral stenosis. Am J Cardiol 1999;83:1206–9. https://doi.org/10.1016/s0002-9149(99)00060-0.Search in Google Scholar
11. Woller, T, Lawall, H, Amann, B, Angelkort, B. Comparison of haemostatic parameters in arterial and venous blood from patients with peripheral arterial occlusive disease. Vasa 1999;28:10–4. https://doi.org/10.1024/0301-1526.28.1.10.Search in Google Scholar PubMed
12. Peverill, RE, Harper, RW, Gan, TE, Smolich, JJ. Increased left atrial thrombin generation in mitral stenosis is not reflected in arterial prothrombin fragment 1+2 levels. Clin Sci 2000;98:501–6. https://doi.org/10.1042/cs19990244.Search in Google Scholar
13. Haines, AP, Newman, R, Howarth, DJ. Levels of haemostatic variables in arterial and venous blood from patients with ischaemic heart disease. Thromb Res 1979;16:421–6. https://doi.org/10.1016/0049-3848(79)90089-6.Search in Google Scholar
14. Chakrabarti, R, Birks, PM, Fearnley, GR. Origin of blood fibrinolytic activity from veins and its bearing on the fate of venous thrombi. Lancet 1963;1:1288–90. https://doi.org/10.1016/s0140-6736(63)91984-6.Search in Google Scholar
15. Frumento, RJ, Hirsh, AL, Parides, MK, Bennett-Guerrero, E. Differences in arterial and venous thromboelastography parameters: potential roles of shear stress and oxygen content. J Cardiothorac Vasc Anesth 2002;16:551–4. https://doi.org/10.1053/jcan.2002.126946.Search in Google Scholar PubMed
16. Kafian, S, Mobarrez, F, Kalani, M, Wallen, H, Samad, BA. Comparison of venous and arterial blood sampling for the assessment of platelet aggregation with whole blood impedance aggregometry. Scand J Clin Lab Invest 2011;71:637–40. https://doi.org/10.3109/00365513.2011.604731.Search in Google Scholar PubMed
17. Oswald, E, Finsterwalder, T, Innerhofer, N, Haas, T, Mittermayr, M, Strohmaier, S, et al.. Comparison of arterial versus venous parameters of rotational thromboelastometry and multiple platelet function analyzer: results of a pilot study. Scand J Clin Lab Invest 2013;73:538–45. https://doi.org/10.3109/00365513.2013.818707.Search in Google Scholar PubMed
18. Tornudd, M, Rodwan Al Ghraoui, M, Wahlgren, S, Bjorkman, E, Berg, S, Kvitting, JE, et al.. Quantification of platelet function – a comparative study of venous and arterial blood using a novel flow cytometry protocol. Platelets 2022:1–9. https://doi.org/10.1080/09537104.2021.2019209.Search in Google Scholar PubMed
19. Karlsson, M, Roman-Emanuel, C, Thimour-Bergstrom, L, Hakimi, CS, Jeppsson, A. Sampling conditions influence multiple electrode platelet aggregometry in cardiac surgery patients. Scand Cardiovasc J 2013;47:98–103. https://doi.org/10.3109/14017431.2012.743672.Search in Google Scholar PubMed
20. Rondina, MT, Grissom, CK, Men, S, Harris, ES, Schwertz, H, Zimmerman, GA, et al.. Whole blood flow cytometry measurements of in vivo platelet activation in critically-Ill patients are influenced by variability in blood sampling techniques. Thromb Res 2012;129:729–35. https://doi.org/10.1016/j.thromres.2011.11.031.Search in Google Scholar PubMed PubMed Central
21. Shah, B, Sedlis, SP, Mai, X, Amoroso, NS, Guo, Y, Lorin, JD, et al.. Comparison of platelet activity measurements by use of arterial and venous blood sampling. J Thromb Haemostasis 2013;11:1922–4. https://doi.org/10.1111/jth.12370.Search in Google Scholar PubMed PubMed Central
22. Durila, M, Kalincik, T, Jurcenko, S, Pelichovska, M, Hadacova, I, Cvachovec, K. Arteriovenous differences of hematological and coagulation parameters in patients with sepsis. Blood Coagul Fibrinolysis 2010;21:770–4. https://doi.org/10.1097/mbc.0b013e32834013d7.Search in Google Scholar
23. Manspeizer, HE, Imai, M, Frumento, RJ, Parides, MK, Mets, B, Bennett-Guerrero, E. Arterial and venous thrombelastograph variables differ during cardiac surgery. Anesth Analg 2001;93:277–81. 1st contents page. https://doi.org/10.1213/00000539-200108000-00007.Search in Google Scholar
24. Tuovila, M, Erkinaro, T, Savolainen, ER, Laurila, P, Ohtonen, P, Ala-Kokko, T. The impact of sample site and storage on thromboelastography values. Am J Hematol 2017;92:E160–2. https://doi.org/10.1002/ajh.24766.Search in Google Scholar PubMed
25. Hering, J, Amann, B, Angelkort, B, Rottmann, M. Thrombin-antithrombin complex and the prothrombin fragment in arterial and venous blood of patients with peripheral arterial disease. Vasa 2003;32:193–7. https://doi.org/10.1024/0301-1526.32.4.193.Search in Google Scholar PubMed
26. Murshid, WR, Gader, AG. The coagulopathy in acute head injury: comparison of cerebral versus peripheral measurements of haemostatic activation markers. Br J Neurosurg 2002;16:362–9. https://doi.org/10.1080/0268869021000007597.Search in Google Scholar PubMed
27. Pedersen, OH, Larsen, ML, Grove, EL, van Kooten Niekerk, PB, Bonlokke, S, Nissen, PH, et al.. Platelet characteristics in patients with essential thrombocytosis. Cytometry B Clin Cytom 2018;94:918–27. https://doi.org/10.1002/cyto.b.21642.Search in Google Scholar PubMed
28. Lundbech, M, Krag, AE, Christensen, TD, Hvas, AM. Thrombin generation, thrombin-antithrombin complex, and prothrombin fragment F1+2 as biomarkers for hypercoagulability in cancer patients. Thromb Res 2020;186:80–5. https://doi.org/10.1016/j.thromres.2019.12.018.Search in Google Scholar PubMed
29. Neergaard-Petersen, S, Mogensen, VB, Veirup, MS, Grove, EL, Kristensen, SD, Hvas, AM. Fibrin clot lysis assay: establishment of a reference interval. Thromb Res 2018;167:9–11. https://doi.org/10.1016/j.thromres.2018.04.025.Search in Google Scholar PubMed
30. Larsen, JB, Hvas, AM. Fibrin clot formation and lysis in plasma. Methods Protoc 2020;3:67. https://doi.org/10.3390/mps3040067.Search in Google Scholar PubMed PubMed Central
31. Chen, MC, Wu, CJ, Yip, HK, Chang, HW, Fang, CY, Yu, TH, et al.. Left atrial platelet activity with rheumatic mitral stenosis: correlation study of severity and platelet P-selectin expression by flow cytometry. Chest 2003;124:1663–9. https://doi.org/10.1378/chest.124.5.1663.Search in Google Scholar PubMed
32. Kjeldsen, J, Lassen, JF, Petersen, PH, Brandslund, I. Biological variation of international normalized ratio for prothrombin times, and consequences in monitoring oral anticoagulant therapy: computer simulation of serial measurements with goal-setting for analytical quality. Clin Chem 1997;43:2175–82. https://doi.org/10.1093/clinchem/43.11.2175.Search in Google Scholar
33. McLaren, G, Hanna, C, Mills, L, Bourdeau, J, Cowin, R. Comparison of sampling methods for obtaining accurate coagulation values in hemodialysis patients with heparinized central venous catheters. Nephrol Nurs J 2001;28:632–6.Search in Google Scholar
34. Noble, WS. How does multiple testing correction work? Nat Biotechnol 2009;27:1135–7. https://doi.org/10.1038/nbt1209-1135.Search in Google Scholar PubMed PubMed Central
35. Omote, M, Asakura, H, Takamichi, S, Shibayama, M, Yoshida, T, Kadohira, Y, et al.. Changes in molecular markers of hemostatic and fibrinolytic activation under various sampling conditions using vacuum tube samples from healthy volunteers. Thromb Res 2008;123:390–5. https://doi.org/10.1016/j.thromres.2008.05.008.Search in Google Scholar PubMed
36. Tripodi, A. Usefulness of thrombin generation. Hämostaseologie 2020;40:509–14. https://doi.org/10.1055/a-1200-0417.Search in Google Scholar PubMed
37. Larsen, JB, Hvas, AM. Fibrinolytic alterations in sepsis: biomarkers and future treatment targets. Semin Thromb Hemost 2021;47:589–600. https://doi.org/10.1055/s-0041-1725096.Search in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2022-0567).
© 2022 Walter de Gruyter GmbH, Berlin/Boston
