Parvathy Nithye, Ray Debadrita, Kumar Narender, Punj Priya, Kumar Vasant, Hans Chander, Ahluwalia Jasmina, Singh Surjit, Dhir Varun
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Thromb Thrombolysis. 2025 Jun 14. doi: 10.1007/s11239-025-03128-9.
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.
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).
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.
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.
凝块波形分析（CWA）是一种在血浆纤维蛋白凝块形成过程中持续监测透光率或吸光度变化的技术，可增强常规凝血试验评估。狼疮抗凝物（LA）患者和甲型血友病（HA）患者均表现为活化部分凝血活酶时间（aPTT）单独延长；然而，它们的处理方式有显著差异。CWA有助于区分这些情况，特别是在标准凝血试验结果不明确且无法进行专门检测的病例中。
这项前瞻性病例对照研究纳入了确诊为LA的患者（n = 69）、健康对照者（n = 75）以及患病对照者[有抑制剂的HA患者（n = 16）和无抑制剂的HA患者（n = 36）]。
与无抑制剂的HA患者相比，aPTT延长的LA阳性样本中，aPTT - CWA的定量数据，包括速度峰值时间、加速度峰值时间和加速度高度[-]显著更低。在无抑制剂的HA样本中，包括一阶导数中的肩部、二阶导数中的双相波[-]和二阶导数中的锯齿波模式的定性数据显著更常见。与健康对照者相比，aPTT正常的LA阳性患者的速度峰值时间和速度高度显著更低，而速度宽度更高。在加速度峰值时间和加速度宽度[-]峰值方面显著更高，而加速度高度[+]和加速度高度[-]更低。加速度高度[-]、加速度宽度[-]和速度宽度的曲线下面积在统计学和生物学上具有显著意义。二阶导数中的肩部在LA阳性样本中显著更常见。
aPTT - CWA在区分有无抑制剂的LA阳性样本和HA样本方面效用有限。然而，aPTT - CWA可能有助于选择aPTT正常且有相关病史值得进一步进行LA确诊检测的患者。
