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. 2020 Jan-Dec:26:1076029620912027.
doi: 10.1177/1076029620912027.

Update on the Clot Waveform Analysis

Hideo Wada  1   2 , Takeshi Matsumoto  3 , Kohshi Ohishi  3 , Katsuya Shiraki  1   2 , Motomu Shimaoka  4
Affiliations

Update on the Clot Waveform Analysis

Hideo Wada et al. Clin Appl Thromb Hemost. 2020 Jan-Dec.

Abstract

The activated partial thromboplastin time (APTT)-clot waveform analysis (CWA) was previously reported to be associated with the early detection of disseminated intravascular coagulation and was also reported to be able to measure very low levels of coagulation factor VIII activity. The software program for the analysis for the APTT-CWA allows the associated first and second derivative curves (first and second DCs) to be displayed. The first and second DC reflect the velocity and acceleration, respectively. The height of the first DC reflects the "thrombin burst" and bleeding risk, while that of the second DC is useful for detecting any coagulation factor deficiency and abnormal enhancement of coagulation by phospholipids. Activated partial thromboplastin time-CWA aids in making a differential diagnosis which is difficult to do using only the routine APTT. The CWA is currently used for many applications in the clinical setting, including the monitoring of hemophilia patients and patients receiving anticoagulant therapy and the differential diagnosis of diseases.

Keywords: APTT; CWA; DIC; hemophilia.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The hemostatic system including the clotting cascade, thrombin burst, and the enhancement of clotting activation by phospholipid. FM indicates fibrin monomer; FV, coagulation factor V; FVa, activated FV; FVII, coagulation factor VII; FVIIa, activated FVII; FVIII, coagulation factor VIII; FVIIIa, activated FVIII; FIX, coagulation factor IX; FIXa, activated FIX; FX, coagulation factor X; FXa, activated FX; FXI, coagulation factor XI; FXIa, activated FXI; FXII, coagulation factor XII; FXIIa, activated FXII.
Figure 2.
Figure 2.
Parameters of CWA (APTT). a indicates acceleration (second derivative curve, DC); APTT, activated partial thromboplastin time; CWA, clot waveform analysis; F, fibrin formation curve; v, velocity (first derivative curve; DC); 1, peak time; 2, peak height; 3, peak width.
Figure 3.
Figure 3.
Development of CWA (APTT). New waveform shows fibrin formation curve, first derivative curve and second derivative curve. APTT indicates activated partial thromboplastin time; CWA; clot waveform analysis; IL, Instrumentation Laboratory; PL, phospholipid; WF, waveform.
Figure 4.
Figure 4.
The CWA (APTT) in mild hemophilia (A, E), severe hemophilia (B, F), hemophilia with inhibitor (C, G), and lupus anticoagulant (D, H). Upper column (A-D), automatic enlargement of the waveform; Lower column (E-H), without the automatic enlargement of the waveform. APTT indicates activated partial thromboplastin time; CWA; clot waveform analysis.
Figure 5.
Figure 5.
The CWA (APTT and small amount of tissue factor; TF/coagulation factor IX; FIX assay) in patients with inhibitor treated with activated prothrombin complex concentrate (APCC, A and D), recombinant human activated coagulation factor VII (rhVIIa, B and E) or emicizumab (C and F). Upper column (A-C), APTT/CWA; Lower column (D-F), small amount of TF/FIX assays (D-F), APTT indicates activated partial thromboplastin time; CWA; clot waveform analysis.
Figure 6.
Figure 6.
The APTT-CWA in various APTT reagents for normal plasma and 1% of FVIII plasma. 1, normal plasma; 2, 1% of FVIII plasma; (A) Sekisui Coagpia APTT-N; (B) Sysmex Thrombocheck APTT; (C), Sysmex Thrombocheck APTT-SLA; (D) Datafei APTT(FS). Actine FS; (E) Datafei APTT(FSL) Actine FSL; (F) Datafei APTT Actine; (G) Stago; (H) IL Synthetic. APTT indicates activated partial thromboplastin time; CWA; clot waveform analysis; FVIII, coagulation factor VIII.
Figure 7.
Figure 7.
Difference in the APTT-CWA between edoxaban and warfarin treatment, A and C, Before treatment with edoxaban or warfarin; (B) treatment with edoxaban; (D) treatment with warfarin. APTT-CWA indicates activated partial thromboplastin time–clot waveform analysis.
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