Clot waveform analysis in haemostatic and systemic disorders: current applications and clinical potential

Clot waveform analysis (CWA), originate from conventional coagulation assays, particularly the activated partial thromboplastin time (APTT) and prothrombin time (PT), offers enhanced sensitivity and dynamic profiling of haemostatic processes. By capturing real-time changes in clot formation kinetics, CWA patterns provide disease specific changes beyond traditional clotting time. It has potential clinical utility in identifying bleeding risk in inherited and acquired bleeding disorders, as well as prothrombotic states in condition such as infections and myocardial infarction. A unique APTT second-derivative curves have been reported in COVID-19 infection. In malignancy, it may help clinicians to mitigate the risk of developing thrombotic complications due to cancer-associated hypercoagulability. This review covers the principles, analytical parameters, and clinical applications of CWA. As evidence continues to grow, integrating CWA into standard coagulation testing algorithms, particularly with the use of artificial intelligence, may potentially lead to improvements in patient stratification, monitoring and management in both acute and chronic haemostatic disorders.