Clot Waveform Analysis for Monitoring Hemostasis.

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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Dr. Nogami reports grants and personal fees from Sysmex Co., grants and personal fees from SEKISUI MEDICAL, Co., during the conduct of the study; grants, personal fees and non-financial support from Chugai Pharmaceutical Co., grants and personal fees from Takeda Pharmaceutical Co., grants and personal fees from Sanofi S. A., grants and personal fees from CSL Behring Co., grants and personal fees from KM Biologics Co., grants and personal fees from Novo Nordisk A/S, grants and personal fees from Bayer AG, grants and personal fees from Fujimoto Seiyaku, outside the submitted work. In addition, Dr. Nogami has a patent relating to emicizumab pending.