Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 14.
doi: 10.1007/s11239-025-03128-9. Online ahead of print.

The role of activated partial thromboplastin time-clot waveform analysis in distinguishing positive samples of lupus anticoagulant from hemophilia A

Nithye Parvathy  1 , Debadrita Ray  1 , Narender Kumar  2 , Priya Punj  1 , Vasant Kumar  1 , Chander Hans  1 , Jasmina Ahluwalia  1 , Surjit Singh  3 , Varun Dhir  4
Affiliations

The role of activated partial thromboplastin time-clot waveform analysis in distinguishing positive samples of lupus anticoagulant from hemophilia A

Nithye Parvathy et al. J Thromb Thrombolysis. .

Abstract

Introduction: Clot waveform analysis (CWA) is a technique that continuously monitors changes in light transmittance or absorbance during fibrin clot formation in plasma, enhancing routine clotting test assessment. Patients with Lupus Anticoagulant (LA) and Hemophilia A (HA) both exhibit isolated prolongation of activated partial thromboplastin time (aPTT); however, their management differs significantly. CWA can aid in distinguishing between these conditions, particularly in cases where standard coagulation tests are inconclusive and specialized assays are unavailable.

Methods: This prospective case-control study included patients with demonstrable LA (n = 69), healthy controls (n = 75) and diseased controls [HA with (n = 16) and without inhibitor (n = 36).

Results: The quantitative data of aPTT-CWA including velocity peak time, acceleration peak time and height of acceleration [-] were significantly lower in LA-positive samples with prolonged aPTT in comparison with HA without inhibitors. The qualitative data comprising Shoulder in 1st derivative, Biphasic wave in 2nd derivative [-] and Serrated wave pattern in 2nd derivative were significantly common in HA samples without inhibitors. In comparison to healthy controls, LA-positive patients with normal aPTT had significantly lower velocity peak time and height of velocity along with higher width of velocity. In acceleration peak time and width of acceleration [-] peak were significantly higher along with lower height of acceleration [+] and height of acceleration [-]. AUROCs of height of acceleration [-], width of acceleration [-] and width of velocity were statistically and biologically significant. The shoulder in 2nd derivative was significantly common in LA-positive samples.

Conclusion: The aPTT-CWA has limited utility for differentiating LA positive from HA samples with and without inhibitors. However, aPTT-CWA may help in selecting patients with normal aPTT who merit further confirmatory testing for LA with a compatible history.

Keywords: Activated partial thromboplastin time-clot waveform analysis; Factor VIII; Hemophilia; Lupus anticoagulant.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics of approval: The study was approved by the Institutional Ethical Committee. Patient consent: Patient consent was taken. Permission to reproduce material from other sources: Authors won work. No material is reproduced from other sources. Consent to participate: Written informed consent was taken from all participants in the study. Clinical trial registration: Not applicable. Conflicts of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Competing interests: The authors declare no competing interests.

Similar articles

See all similar articles

References

    1. Su Z, Braun PJ, Klemp KF, Baker KR, Thames EH, Ortel TL (2002) Abnormal optical waveform profiles in coagulation assays from patients with antiphospholipid antibodies. Blood Coagul Fibrinolysis 13(1):7–17 - DOI - PubMed
    1. Wada H, Shiraki K, Matsumoto T, Shimpo H, Shimaoka M (2023) Clot waveform analysis for hemostatic abnormalities. Ann Lab Med 43(6):531–538 - DOI - PubMed - PMC
    1. Mannan KA, Kumar N, Ahluwalia J, Hans C, Kler A, Prakash G, Jain R (2023) The activated partial thromboplastin time-clot waveform analysis in hemophilia: does it help in differentiation? Int J Lab Hematol 45(2):241–249 - DOI - PubMed
    1. Zhang S, Wu Z, Li P, Bai Y, Zhang F, Li Y (2015) Evaluation of the clinical performance of a novel chemiluminescent immunoassay for detection of anticardiolipin and Anti-Beta2-Glycoprotein 1 antibodies in the diagnosis of antiphospholipid syndrome. Med (Baltim) 94(46):e2059 - DOI
    1. Noordermeer T, Molhoek JE, Schutgens REG et al (2021) Anti-β2-glycoprotein I and anti-prothrombin antibodies cause lupus anticoagulant through different mechanisms of action. J Thromb Haemost 19(4):1018–1028 - DOI - PubMed - PMC

LinkOut - more resources