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<p>Activated partial thromboplastin time (APTT)–based clot waveform analysis (CWA) or clot curve analysis extends conventional coagulation testing by capturing continuous optical changes during clot formation. Hemophilia, due to intrinsic pathway factor deficiency, results in impaired thrombin generation and delayed fibrin formation. CWA provides quantitative and qualitative assessment of coagulation kinetics and may complement routine APTT and factor assays. This study evaluated clot waveform parameters and patterns in hemophilia and correlated them with factor levels and severity. A cross-sectional analytical study was conducted in the coagulation laboratory (January 2023 to March 2024). One hundred samples were analyzed, including 50 hemophilia patients (45 hemophilia A, 5 hemophilia B) and 50 healthy controls. APTT-CWA was performed using a photo-optical detection system (ACL TOP 300 analyzer with SynthASil reagent). Ten CWA parameters encompassing fibrin formation time, velocity and acceleration timings, peak heights, and curve widths were recorded. Waveform morphology was assessed visually. Statistical analysis was performed using STATA 14.0. All CWA parameters differed significantly between hemophilia and control groups (<i>p</i> &lt; 0.0001). Hemophiliacs showed prolonged fibrin formation, delayed velocity and acceleration peaks, widened kinetic curves, and reduced peak heights. Abnormal patterns included incomplete fibrin plateau (28%), camel-hump (22%), double peaks (20%), serrated curves (18%), and deceleration troughs (52%). Progressive worsening of abnormalities was observed with increasing severity (<i>p</i> &lt; 0.001). FVIII levels correlated negatively with time-based parameters (<i>r</i>= -0.45 to -0.49) and widths (<i>r</i>= -0.41 to -0.51), and positively with velocity and acceleration heights (<i>r</i> = 0.32 to 0.35). APTT-CWA effectively differentiates hemophilia from normal coagulation and reflects disease severity, supporting its role as a complementary diagnostic tool.</p>

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Clot Waveform Analysis of Activated Partial Thromboplastin Time for Evaluating Hemostatic Abnormalities and Severity in Hemophilia: A Cross-Sectional Study of Fibrin Formation and Thrombin Dynamics

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Susmitha Santhosh,
  • Prabhu Manivannan,
  • Jeyanthi Anandraj,
  • Rakhee Kar

摘要

Activated partial thromboplastin time (APTT)–based clot waveform analysis (CWA) or clot curve analysis extends conventional coagulation testing by capturing continuous optical changes during clot formation. Hemophilia, due to intrinsic pathway factor deficiency, results in impaired thrombin generation and delayed fibrin formation. CWA provides quantitative and qualitative assessment of coagulation kinetics and may complement routine APTT and factor assays. This study evaluated clot waveform parameters and patterns in hemophilia and correlated them with factor levels and severity. A cross-sectional analytical study was conducted in the coagulation laboratory (January 2023 to March 2024). One hundred samples were analyzed, including 50 hemophilia patients (45 hemophilia A, 5 hemophilia B) and 50 healthy controls. APTT-CWA was performed using a photo-optical detection system (ACL TOP 300 analyzer with SynthASil reagent). Ten CWA parameters encompassing fibrin formation time, velocity and acceleration timings, peak heights, and curve widths were recorded. Waveform morphology was assessed visually. Statistical analysis was performed using STATA 14.0. All CWA parameters differed significantly between hemophilia and control groups (p < 0.0001). Hemophiliacs showed prolonged fibrin formation, delayed velocity and acceleration peaks, widened kinetic curves, and reduced peak heights. Abnormal patterns included incomplete fibrin plateau (28%), camel-hump (22%), double peaks (20%), serrated curves (18%), and deceleration troughs (52%). Progressive worsening of abnormalities was observed with increasing severity (p < 0.001). FVIII levels correlated negatively with time-based parameters (r= -0.45 to -0.49) and widths (r= -0.41 to -0.51), and positively with velocity and acceleration heights (r = 0.32 to 0.35). APTT-CWA effectively differentiates hemophilia from normal coagulation and reflects disease severity, supporting its role as a complementary diagnostic tool.