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Iberahim S, Muhamat Yusoff R, Mohd Noor NH, Hassan R, Ramli NN, Bahar R, Zulkafli Z, Wan Ab Rahman WS, Ab Ghani AS. Coagulation Status Using Clot Wave Analysis in Patients With Prolonged Immobilization. Cureus 2024; 16:e51483. [PMID: 38304638 PMCID: PMC10830393 DOI: 10.7759/cureus.51483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/03/2024] Open
Abstract
Background Prolonged immobilization is widely recognized as a risk factor for thromboembolism. In this prospective study, we investigated the changes in clot waveform analysis (CWA) parameters in prolonged immobilized patients following lower limb trauma. CWA is an advanced method for assessing global coagulation that involves continuously monitoring changes in light transmittance, absorbance, or light scattering during routine clotting tests. Additionally, we also aim to determine the CWA parameters between day one and after day three of immobilization. Methods A total of 30 patients with prolonged immobilization were enrolled in this study. The plasma of these patients was collected on the first day of their admission and subsequently obtained again after day three of immobilization. Prothrombin time (PT)-based CWA and activated partial thromboplastin time (aPTT)-based CWA were performed using the ACL TOP 300 CTS (Werfen: Bedford, USA) coagulation analyzer, which utilizes the optical method for clot detection. Plasma samples for 20 normal controls were recruited from a healthy blood donor. The CWA parameters generated during clot formation were analyzed. For the comparison of CWA parameters between patients with prolonged immobilization and healthy controls, the Mann-Whitney test was used. A paired t-test was used for the comparison of clot wave parameters between day one and after day three of immobilization. This study was approved by the Universiti Sains Malaysia Research Ethics Committee. Result The mean values of PT and aPTT in healthy controls were 11.66 seconds and 33.98 seconds, respectively. There was no statistically significant difference between the patients and the healthy controls in the median values of aPTT (P=0.935). However, patients with prolonged immobilization exhibited significantly higher median PT CWA parameter values than controls (P=0.007). These parameters included the delta change (P<0.001), peak time velocity (P=0.008), and height velocity (P<0.001). On the other hand, the delta change (P<0.001) and height velocity (P<0.001) of the aPTT CWA parameters were significantly higher in patients with prolonged immobilization than in controls. In patients with prolonged immobilization, there was no significant difference in PT CWA parameters between day one and after day three of immobilization, while for aPTT CWA, all parameters were higher on day three, except for the endpoint time. Conclusion Patients with prolonged immobilization exhibit increased PT and aPTT CWA parameters compared to normal controls. CWA parameters could aid in identifying patients at risk of developing thrombosis through changes in the clot waveform. However, further study is needed to fully utilize additional information from routine coagulation testing.
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Affiliation(s)
- Salfarina Iberahim
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | | | - Rosline Hassan
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Noor Nabila Ramli
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Rosnah Bahar
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Zefarina Zulkafli
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Wan Suriana Wan Ab Rahman
- Basic and Medical Sciences Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
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Nogami K. Clot Waveform Analysis for Monitoring Hemostasis. Semin Thromb Hemost 2023; 49:592-599. [PMID: 36174610 DOI: 10.1055/s-0042-1756706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Clot waveform analysis (CWA) is a recently developed global coagulation assessment, based on the continuous observation of changes in light transmittance, absorbance, or light scattering that occurs as fibrin formed in a plasma sample during routine clotting tests such as activated partial thromboplastin time (aPTT) and prothrombin time (PT). CWA can utilize qualitative waveform patterns as well as sensitive quantitative parameters and can be used as a simple method to assess global hemostasis, and can be applied to various challenging clinical situations. Although not all coagulation analyzers currently in use are able to provide CWA, the number of analyzers available to do so is increasing, as the usefulness of this process has become more widely recognized. CWA can be based on the coagulation mechanism of aPTT, an intrinsic trigger, and this has been reported in many studies, including diagnosis and treatment of patients with hemophilia, disseminated intravascular coagulation, and monitoring of anticoagulants and thrombosis. CWA using trace amounts of tissue factors also has the potential to expand the applications of this technology. Recently, there have been reports of the combined evaluation of fibrinolytic dynamics. Among the existing global coagulation assays, CWA may prove to be the easiest to standardize in clinical practice. However, more extensive testing using standardized methods in various clinical settings is needed to determine the true role of CWA in the evaluation of hemostasis and thrombosis in the future.
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Affiliation(s)
- Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
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Wong WH, Tan CW, Abdul Khalid NB, Dalimoenthe NZ, Yip C, Tantanate C, Lim RD, Kim JH, Ng HJ. Reagent Effects on the Activated Partial Thromboplastin Time Clot Waveform Analysis: A Multi-Centre Study. Diagnostics (Basel) 2023; 13:2447. [PMID: 37510191 PMCID: PMC10377778 DOI: 10.3390/diagnostics13142447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: The activated partial thromboplastin time (APTT)- based clot waveform analysis (CWA) quantitatively extends information obtained from the APTT waveform through its derivatives. However, pre-analytical variables including reagent effects on the CWA parameters are poorly understood and must be standardized as a potential diagnostic assay. (2) Methods: CWA was first analysed with patient samples to understand reagent lot variation in three common APTT reagents: Pathromtin SL, Actin FS, and Actin FSL. A total of 1055 healthy volunteers were also recruited from seven institutions across the Asia-Pacific region and CWA data were collected with the Sysmex CS analysers. (3) Results: CWA parameters varied less than 10% between lots and the linear mixed model analysis showed few site-specific effects within the same reagent group. However, the CWA parameters were significantly different amongst all reagent groups and thus reagent-specific 95% reference intervals could be calculated using the nonparametric method. Post-hoc analysis showed some degree of influence by age and gender with weak correlation to the CWA (r < 0.3). (4) Conclusions: Reagent type significantly affects APTT-based CWA with minimal inter-laboratory variations with the same coagulometer series that allow for data pooling across laboratories with more evidence required for age- and gender-partitioning.
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Affiliation(s)
- Wan Hui Wong
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore
| | - Chuen Wen Tan
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore
| | | | | | - Christina Yip
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Singapore
| | | | - Rodelio D Lim
- Institute of Pathology, St Luke's Medical Centre, Global City 1634, Philippines
| | - Ji Hyun Kim
- Department of Pathology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Heng Joo Ng
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore
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Ruberto MF, Marongiu F, Barcellona D. Performance and Interpretation of Clot Waveform Analysis. Methods Mol Biol 2023; 2663:163-173. [PMID: 37204709 DOI: 10.1007/978-1-0716-3175-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The prothrombin time (PT) and the activated partial thromboplastin time (aPTT) are two basic tests for routine purposes, which are widely used in the clinical screening of coagulopathies. PT and aPTT are useful tests for detecting both symptomatic (hemorrhagic) and asymptomatic defects, but they are unsuitable for studying hypercoagulable states. However, these tests are available for studying the dynamic process of clot formation by means of the detection of the clot waveform analysis (CWA), which has been introduced several years ago. CWA can provide useful information on both hypocoagulable and hypercoagulable states. Nowadays it is possible to detect the whole clot formation both in the PT and aPTT tubes starting from the initial step of fibrin polymerization by means of specific and dedicated algorithm implemented in a coagulometer. In particular, CWA provides information on the velocity (first derivative), acceleration (second derivative), and density (delta) of clot formation. CWA has been applied to several pathologic conditions such as coagulation factor deficiency (including congenital hemophilia from factor VIII, IX, or XI deficiency), acquired hemophilia, disseminated intravascular coagulation (DIC), sepsis, replacement therapy management, chronic spontaneous urticarial, and liver cirrhosis, in patients with high venous thromboembolic risk before LMWH prophylaxis, and in patients with different hemorrhagic patterns along with an electron microscopy evaluation of the clot density. We report here materials and methods used for detecting the additional clotting parameters available in both PT and aPTT.
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Affiliation(s)
- Maria Filomena Ruberto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- SHRO, Temple University, Philadelphia, PA, USA
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Abstract
OBJECTIVES We aimed to describe the variation of hemostasis proteins in children with bacterial infections due to different pathogens ( Neisseria meningitidis, Streptococcus pneumoniae, Staphylococcus aureus , and group A streptococcus [GAS]) and to study hemostasis proteins in relation to mortality. DESIGN Preplanned analysis in prospective cohort study. SETTING Hospitals in five European countries (Austria, The Netherlands, Spain, Switzerland, and the United Kingdom). PATIENTS Admitted children (2012-2016) with community-acquired infections due to meningococci ( n = 83), pneumococci ( n = 64), S. aureus (n = 50), and GAS ( n = 44) with available serum samples collected less than 48 hours after admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Fibronectin, plasminogen activator inhibitor type 1 (PAI-1), thrombomodulin, and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13) were measured in serum in 2019-2020. Additionally, von Willebrand factor, protein C, protein S, and factor IX were measured in citrate plasma available from a subset of patients. Outcome measures included in-hospital mortality and disease severity (need for ventilation/inotropes, Pediatric Index of Mortality score).Of 241 children, 21 (8.7%) died and 177 (73.5%) were admitted to PICU. Mortality rate was similar for the pathogen groups. Levels of fibronectin and thrombomodulin differed for the different pathogens ( p < 0.05). Fibronectin levels were lower in GAS infections than in S. pneumoniae and S. aureus infections but did not differ from meningococcal infections. Thrombomodulin levels in meningococcal infections were higher than in S. aureus and pneumococcal infections. Overall, the area under the curve for mortality was 0.81 (95% CI, 0.70-0.92) for thrombomodulin and 0.78 (95% CI, 0.69-0.88) for ADAMTS-13. The association of each hemostasis protein did not vary across pathogens for any of the outcome measures. CONCLUSIONS Hemostatic disturbances in childhood bacterial infections are not limited to meningococcal sepsis but occur with a comparable severity across nonmeningococcal infections. High thrombomodulin and high ADAMTS-13 had good discriminative ability for mortality. Our results emphasize the importance of hemostatic disturbances in meningococcal and nonmeningococcal pediatric bacterial infections.
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Kato K, Hatayama Y, Shimohiro H, Ichikawa H, Fukuda T. Differences in the Composition of Activated Partial Thromboplastin Time (APTT) Reagents Affect Clot Waveform Analysis. Yonago Acta Med 2022. [DOI: 10.33160/yam.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Konami Kato
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Yuki Hatayama
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Hisashi Shimohiro
- Department of Pathobiological Science and Technology, School of Health Sciences, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hitomi Ichikawa
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Tetsuya Fukuda
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
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Kato K, Hatayama Y, Shimohiro H, Ichikawa H, Fukuda T. Differences in the Composition of Activated Partial Thromboplastin Time (APTT) Reagents Affect Clot Waveform Analysis. Yonago Acta Med 2022; 65:226-230. [DOI: 10.33160/yam.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Konami Kato
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Yuki Hatayama
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Hisashi Shimohiro
- Department of Pathobiological Science and Technology, School of Health Sciences, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hitomi Ichikawa
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
| | - Tetsuya Fukuda
- Division of Clinical Laboratory, Tottori University Hospital, Yonago 683-8504, Japan and
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Tan CW, Tan JY, Wong WH, Cheong MA, Ng IM, Conceicao EP, Low JGH, Ng HJ, Lee LH. Clinical and laboratory features of hypercoagulability in COVID-19 and other respiratory viral infections amongst predominantly younger adults with few comorbidities. Sci Rep 2021; 11:1793. [PMID: 33469056 PMCID: PMC7815883 DOI: 10.1038/s41598-021-81166-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and other respiratory viral (non-CoV-2-RV) infections are associated with thrombotic complications. The differences in prothrombotic potential between SARS-CoV-2 and non-CoV-2-RV have not been well characterised. We compared the thrombotic rates between these two groups of patients directly and further delved into their coagulation profiles. In this single-center, retrospective cohort study, all consecutive COVID-19 and non-CoV-2-RV patients admitted between January 15th and April 10th 2020 were included. Coagulation parameters studied were prothrombin time and activated partial thromboplastin time and its associated clot waveform analysis (CWA) parameter, min1, min2 and max2. In the COVID-19 (n = 181) group there were two (1.0 event/1000-hospital-days) myocardial infarction events while one (1.8 event/1000-hospital-day) was reported in the non-CoV-2-RV (n = 165) group. These events occurred in patients who were severely ill. There were no venous thrombotic events. Coagulation parameters did not differ throughout the course of mild COVID-19. However, CWA parameters were significantly higher in severe COVID-19 compared with mild disease, suggesting hypercoagulability (min1: 6.48%/s vs 5.05%/s, P < 0.001; min2: 0.92%/s2 vs 0.74%/s2, P = 0.033). In conclusion, the thrombotic rates were low and did not differ between COVID-19 and non-CoV-2-RV patients. The hypercoagulability in COVID-19 is a highly dynamic process with the highest risk occurring when patients were most severely ill. Such changes in haemostasis could be detected by CWA. In our population, a more individualized thromboprophylaxis approach, considering clinical and laboratory factors, is preferred over universal pharmacological thromboprophylaxis for all hospitalized COVID-19 patients and such personalized approach warrants further research.
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Affiliation(s)
- Chuen Wen Tan
- Department of Haematology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
| | - Jing Yuan Tan
- SingHealth Internal Medicine Residency, Singapore General Hospital, Singapore, Singapore
| | - Wan Hui Wong
- Department of Haematology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - May Anne Cheong
- Department of Haematology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - Ian Matthias Ng
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Jenny Guek Hong Low
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- Programme in Emerging Infectious Diseases, Duke NUS Medical School, Singapore, Singapore
| | - Heng Joo Ng
- Department of Haematology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - Lai Heng Lee
- Department of Haematology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
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