Analysis of APTT Based Clot Waveform Parameters in Various Clinical Conditions Ae A Study at A Tertiary Care Center Rachana Lakhe1.
Amit Nisal1.
Preeti Doshi1.
Ravindra Nimbargi1 Department of pathology.
Bharati Vidyapeeth Deemed to be University and Medical College.
Pune.
India Correspondence:
Doshi Preeti.
Department of Pathology.
Bharati Vidyapeeth Deemed to be University and Medical College.
Pune.
India Zip Code: 411043 Email: prdoshi22@gmail.
Received: June 8, 2022 Revised: January 17, 2023 Accepted: February 10, 2023 Published: April 29, 2023 DOI: 10.
33086/ijmlst.
Abstract Various coagulation tests like Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) are estimated by automated coagulation analyzers.
The newer fully automated analyzers generate clot wave forms aPTTCWA for these parameters are derived.
In this study, the objective was to analyze clot wave form characteristics morphology and its first and second derivative values in cases with abnormal APTT.
ACL TOP 300 generated curves for APTT in a total 125 patients with 20 normal controls are First derivative, second derivative, morphology of curve: sigmoid, biphasic, prolonged pre-coagulation phase, second derivative morphology like early and late shoulder, biphasic peak, delayed deceleration were the analyzed Wave clot forms of 125 patients were included in this study.
Patients (M:F - 2.
2:1, mean age: 46.
9 A 20
A spectrum of clinical conditions was Covid .
%), liver disease .
%), polytrauma .
4%), cardiac diseases .
8%), sepsis/DIC .
2%), thromboembolism .
2%), renal diseases .
4%), bacterial infections .
%), dengue .
%), snake bite .
6%) and factor deficiency .
6%).
Liver and heart disease showed a significant difference in acceleration and deceleration peaks followed by sepsis, dengue, polytrauma and sepsis/DIC.
Deceleration peak was prolonged in patients of Covid .
<0.
Sepsis and liver diseases showed prolonged first derivative peak .
<0.
CWA is very easily available on all automated coagulation It is inexpensive with fast turn round time.
Both quantitative as well as qualitative informations such as velocity, acceleration of clot formation and wave pattern details were recorded.
Our study highlights importance of quantitative and qualitative CWA parameters acquired by performing APTT test for the automated analyzers.
Keywords APTT.
Clot Waveform.
Velocity Acceleration.
Citation: Lakhe R.
Nisal A.
Doshi P.
Nimbargi R.
Analysis of APTT Based Clot Waveform Parameters in Various Clinical Conditions Ae A Study at A Tertiary Care Center.
Indones J Med Lab Sci Technol.
:1Ae9.
DOI: 10.
33086/ijmlst.
This is an open access article distributed under the Creative Commons Attribution-ShareAlike 4.
0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A2023 by author.
Rachana Lakhe, et al.
CWA is a global coagulation assay that INTRODUCTION Clot Waveform Analysis (CWA) is an evaluates the kinetics of fibrin formation extended interrogation of the curve generated during testing of aPTT or PT.
Clot by an optical detection system during the waveforms provide information on light measurement of coagulation assays such as transmittance during clot formation .
Prothrombin Time (PT) and activated Partial Automatic optical end-point coagulation Thromboplastin Time .
PTT).
It detects light analyzers have the ability to show the clot transmittance basd on its absorbance.
This is reaction curve of the PT and APTT and a global hemostatic assay, that reflects the overall hemostatic factor .
Auenhancement of clotting activation by The automated photo-optical coagulation Authrombin burstAy PLs .
analyzers used for the estimation of PT and The plot waveform analyses the slope APTT display the clot reaction curves along generated by optical detection during routine with the first and second derivative curves coagulation tests, such as aPTT or PT.
The .
irst and second DC.
optical detection system generates a clot The height of the first DC in the APTT- formation process with respect to the change CWA is used to reflect to the Authrombin in transmittance and absorbance of the light burstAy as a hemostatic ability.
The low height beam through the sample .
of the first DC in APTT-CWA suggests a risk Continuous measurement of the change of bleeding.
The height of the second DC in in light transmission or absorbance during the APTT-CWA PT and APTT assays is performed and the coagulation factor deficiency .
Thromboelastography (TEG) also shows data are given in the form of a wave.
This generated clot wave has three phases: .
Pre- a different pattern of information, but is Coagulation:
Either slightly expensive and time-consuming .
decreased light transmittance or increased The coagulation system has a specific absorbance along with formation of fibrin is mechanism that includes the cascade system, seen in the clotting process which is seen as thrombin burst and enhancement of clotting slope on waveform, .
Post coagulation:
activation by phospholipids (PL.
Towards the end of coagulation, the light The various available assays which transmittance or absorbance stabilizes, which evaluate the coagulation system these days is seen as a linear segment on the are activated partial thromboplastin time waveform .
PTT).
PT, thromboelastography (TEG).
TGT and thrombin generation test (TGT) .
CWA
information, as both correlate with the rate Ina.
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and velocity of thrombin formation and The parameters studied were the first reflect the entire process of thrombin .
aximum Clinical conditions such as formatio.
, second derivative .
aximum and DIC/Sepsis and prediction of bleeding risk in minimum acceleration and deceleration DIC .
Factor Vi deficiency .
, bacterial during clot wave formatio.
Statistical infections .
Covid 19 .
, patients on anticoagulant therapy exhibit different clot The mean and standard deviation waveform morphology.
The aim of the were calculated for the APTT.
First and present study was to analyze and compare second derivatives.
Mann Whitney U test was clot waveform characteristics, such as performed and p value was determined.
morphology and first- and second-derivative Statisctical significance was set at P<0.
SPS15
values, in cases with abnormal APTT.
RESULTS
MATERIALS AND METHODS
A total of 145 patients were included in It is a prospective cross-sectional study the study, with 20 control samples.
The mean with a duration of 6 months.
A total of 125 age group in the present study was 46.
9 A 20
patients and 20 age matched controls were years with male to female ratio of 2.
2:1.
The included in the study.
All the abnormal APTT ranges of APTT, first, and second derivatives samples were thoroughly selected through in controls and cases were determined (Table .
Patients unfractionated heparin (UFH) or low- The morphology of the clot waveforms molecular-weight heparin (LWMH) were was studied in all 125 cases.
The various clot excluded from the study.
Blood samples were collected in anticoagulant tubes containing biphasic, prolonged pre-coagulation phase, 1:9 volumes of 3.
2% trisodium citrate.
For slow or steep slope, second-derivative obtaining platelet poor plasma: platelet-poor morphology, biphasic peak, and delayed plasma was obtained by centrifugation of the The liver disease and Corona blood samples at 3000 rpm for 15 min.
The Virus Disease 2019 (Covid-.
were the two plasma is analyzed for platelet count on a cell most prevalent conditions among the 125 counter, which should be less than 10000/ per cases in the current investigation.
(Figure .
PT/APTT was performed using an The most common pattern was a sigmoid ACL Top 300 CTS Coagulation Analyzer.
pattern and prolonged pre-coagulation phase.
The morphology of clot waveform in all the Various morphologies of the clot waveforms conditions with abnormal APTT was studied.
in different clinical conditions are shown in Ina.
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Figure 2.
The mean values of APTT and the and sepsis with respect to the first first and second derivatives in each clinical .
<0.
condition were calculated and compared with those of the controls (Table .
Covid-19, sepsis, heart disease, and liver disease with respect to the second derivative found between cases of liver disease .
<0.
(Table .
Table 1.
Range of APTT.
First and Second Derivatives in Cases and Controls Parameters APTT First derivative Second derivative (Acceleratio.
Second derivative (Deceleratio.
Controls Cases 7 to 36.
5 seconds 08 - 354.
87 TU/L
1 - 1212.
81 TU/L
43 - 344.
81 TU/L
29 - 865.
02 TU/L
52 - 563.
867 TU/L
95 - 270.
29 TU/L
Spectrum of clinical condition Morphology of clot wave formation Figure 1.
Spectrum of clinical cases and various morphology patterns of clot wave Ina.
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Figure 2.
Waveforms of normal and biphasic aPTT clots.
On the MDA System, photo-optical monitoring of clot formation yields a sigmoid pattern that looks like a wave.
Table 2.
Mean Values of APTT.
First and Second Derivative in Various Clinical Condition Mean APTT Mean Velocity (First derivativ.
Controls Mean (Second Mean (Second Covid-19 Heart disease Chronic diseases Bacterial Liver Diseases Dengue Factor deficiency Renal diseases Sepsis/DIC Snake bite Venous Ina.
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Table 3.
Association of APTT.
First and Second Derivatives in Various Clinical Conditions Clinical Mann Whitney U
P value Mann Whitney U
P value Mann Whitney U
P value Mann Whitney U
P value Covid
Sepsis Heart disease Liver disease APTT
First
Second
( )
Second
(-)
*P value < 0.
There were two cases of snakebite with CWA is based on APTT and PT tests, abnormally raised APTT and abnormal which are global coagulation tests and is of the clot waveform.
The studied on the principle of optical detection precoagulation phase was entirely distorted system through an automated coagulation and the first and second-derivatives were Various ACL series are widely suggestive of consumptive coagulopathy available and use an automated coagulation (DIC).
In addition, two cases of factor analyzer that works on the light absorbance deficiency (Factor V and Factor V.
showed principle and helps in studying the entire corresponding changes in the clot wave process of hemostasis depicted in the form of pattern with early and late shoulders in the waves as described above .
second derivative curves.
In the present study, clot waveforms detected hemostatic alterations and abnormal patterns in various clinical cases like Covid-
DISCUSSION
Multiple factors, such as the blood vessel DIC/sepsis, coagulation factors are involved in the A rise in the incidence of coagulation cascade.
PT and aPTT are the thrombotic events, such as pulmonary embolism, has been observed in critical ill Covid-19 Coagulation assays are of utmost importance hypercoagulability is been seen in various in this new era.
Ina.
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F Rubereto et al.
, .
studied CWA in factor deficiency in our study with abnormal 191 patients with liver cirrhosis and found clot wave formation, thus providing new insight into the potential utility of CWA in deceleration were lower in the cirrhotic detecting hypercoagulability or risk of patients as compared to the control groups bleeding in various clinical conditions .
which correlate with our study.
Takuya et al.
A study by Kanouchi et al.
, .
studied the clot wave forms of APTT in 26 patients with Covid-19 and the results deceleration/acceleration using clotting waveforms, specifically in derivative morphology .
arly shoulder type patients with LA-positive APS.
Oka et al.
and late shoulder typ.
, which were similar to .
studied the CWA for the assessment of those found in our study.
DOAC effects and provided valuable insights In a study by Tan et al.
, .
of 101 into the relevance of anticoagulation to patients, it was concluded that patients with therapeutic efficacy and bleeding risk from bacterial infections showed significantly the perspective of fibrinolysis.
higher CWA parameters than controls.
CWA is an extended study of the routine contrast, patients with dengue infection had aPTT test that utilizes pre-existing test significantly lower CWA parameters.
This similar observation was also seen in our automated analyzers use changes in light transmittance or absorbance to measure Many Kei et al.
, .
studied the clot wave form clotting times, and these optical changes over in 211 patients of sepsis and showed first and time as clot forms are captured and presented second derivatives curves were useful in as a clot waveform curve in the software of diagnosis and prediction of bleeding risks.
the analyzers .
There was a significant association between As more studies showing the correlation the second derivative and the disease between the clot wave patterns have surfaced, condition in this study.
the importance of full utilization of the data A study by Dave et al.
, .
showed that provided by the automation machines can be the risk of severe bleeding in patients with interpreted without any additional cost and Hemophilia A invariably accompanied by an turn over time .
Clot waveform analysis provides similar generation test, while the Factor Vi level information to TGT, as it correlates with the did not always reflect the actual bleeding rate and velocity of thrombin formation, and Similarly, we had two cases of reflects the whole process of thrombin Ina.
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This contrasts with routine AUTHOR CONTRIBUTIONS coagulation assays, in which clotting time Rachana Lakhe and Preeti Doshi:
only reflects coagulation initiation .
, .
Design, acquisition and analysis of data and drafting of manuscript, statistical analysis CONCLUSIONS CWA is readily available in newer coagulation analyzers.
In addition to routine with critical revision.
Amit Nisal and Ravindra Nimbargi:
The coagulation tests.
CWA, which is readily available without any extra cost, helps study ACKNOWLEDGEMENTS the process of hemostasis in normal as well as abnormal patients without any additional The author thanks the reviewers for their constructive reviews to the paper.
turnaround time.
Quantitative as well as qualitative information was obtained from CONFLICT OF INTEREST the clot waveform analysis, which can be used for clinical decisions.
Our study highlights the importance of quantitative and There between them.
The authors declare that there are no conflicts of interest.
qualitative CWA parameters obtained using a simple APTT test.
REFERENCES