Clinical Application of Clot Waveform Analysis

Clot waveform analysis (CWA) involves an analysis of the activated partial thromboplastin time (CWA-APTT), diluted prothrombin time (CWA-dPT), and small amount of thrombin time (CWA-sTT), and clot fibrinolysis waveform analysis (CFWA). CWA was evaluated in order to propose its clinical application. CWA exhibits an abnormal waveform, as well as peak times and heights in its derivative curves. Although the CWA-APTT is frequently examined and is useful for diagnosing clotting deficiency, it has several limitations. Therefore, modified CWAs have been proposed for clinical application. CWA-dPT (small amount of tissue factor-induced FIX activation; sTF/FIXa) can detect hypercoagulability. CWA-sTT reflects thrombin burst and evaluates hemostatic abnormalities in patients treated with emicizumab. CFWA is a variant of CWA-APTT that includes a small amount of tissue-type plasminogen activator, indicating both clotting and fibrinolysis. The CWA-APTT and modified CWA should be further investigated in various diseases for many applications in the clinical setting, including the monitoring of hemophilia patients and patients receiving anticoagulant therapy, and the differential diagnosis of diseases.