Monitoring of hemostatic abnormalities in major orthopedic surgery patients treated with edoxaban by <scp>APTT</scp> waveform

Hasegawa, Masahiro; Wada, Hideo; Tone, Shine; Yamaguchi, Toshio; Wakabayashi, Hiroki; Itō, Makoto; Watanabe, Masato; Fujimoto, Naoki; Matsumoto, Toshifumi; Ohishi, Kohshi; Yamashita, Yoshiki; Katayama, Naoyuki; Sudo, Akihiro

doi:10.1111/ijlh.12727

Cited by 16 publications

(24 citation statements)

References 21 publications

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“…The APTT was measured using the APTT-SP® including silica as an activator of FXII and synthetic phospholipids (Instrumentation Laboratory, Bedford, MA, USA) using an ACL-TOP® system (Instrumentation Laboratory). After measuring the APTT, we performed a waveform analysis based on the results of each APTT assay [15, 19]. Three types of curves are shown on the monitor of the ACL-TOP® system (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The ACL TOP analyzer for the using APTT-synthetic phospholipids (SPs) recently showed the associated first- and second-derivative peaks (1 st and 2 nd DPs, respectively) [13] It has been reported that the evaluation of the 1 st and 2 nd DPs in the APTT is valuable for diagnosing coagulation factor abnormalities and monitoring anti-Xa inhibitor [14, 15].…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk

et al. 2019

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Background The usefulness of the activated partial thromboplastin time (APTT) waveform has been reported in hemophilia, acquired hemophilia and monitoring for anticoagulants. Material and methods The APTT waveform was examined in patients suspected of having disseminated intravascular coagulation (DIC) to analyze its usefulness for the diagnosis of DIC or the prediction of the outcome or bleeding risk. Results DIC with fibrinogen < 2 g/L was frequently associated with infectious diseases (43.3%). The heights of the first derivative peak (1stDP) and second DP (2ndDP) were extremely low in DIC, especially DIC with hypofibrinogenemia, but high in infectious patients without DIC. The peak time and width of the 1stDP and 2ndDP were prolonged in patients with DIC. The heights of the 1 st DP and 2 nd DP were markedly low in patients with a poor outcome or those with hemoglobin < 8.0 g/dl. Discussion and conclusion As bleeding type DIC was observed in infectious DIC, DIC without hypofibrinogenemia might switch to DIC with hypofibrinogenemia by the progression of DIC. The height of the 1 st DP and 2 nd DP is useful for the diagnosis of DIC and prediction of the bleeding risk or outcome.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk

et al. 2019

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“…Although it is considered unnecessary to monitor patients receiving DOACs, major bleeding is sometimes observed in the patients treated with DOACs. 32 Low levels of anti-Xa activity may be risk of the onset of deep vein thrombosis 33,34 and a prolong APTT-CWA peak time may be a risk factor for major bleeding 35 in orthopedic patients treated with anti-Xa inhibitors. Warfarin decreased the height of the first and second DC in the APTT-CWA and prolonged the width of the first DC in the APTT-CWA, while edoxaban prolonged the peak time of the first and second DC in the APTT-CWA ( Figure 7).…”

Section: Monitoring For Anticoagulant Therapymentioning

confidence: 99%

“…Warfarin decreased the height of the first and second DC in the APTT-CWA and prolonged the width of the first DC in the APTT-CWA, while edoxaban prolonged the peak time of the first and second DC in the APTT-CWA ( Figure 7). 35 These differences in the APTT-CWA of patients treated with anti-Xa inhibitors and those treated with warfarin reflect to the difference in the effects of these drugs. That is, patients with anti-Xa inhibitors are considered to have a lower bleeding tendency.…”

Section: Monitoring For Anticoagulant Therapymentioning

confidence: 99%

Update on the Clot Waveform Analysis

Wada

Matsumoto

Ohishi

et al. 2020

Clin Appl Thromb Hemost

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The activated partial thromboplastin time (APTT)–clot waveform analysis (CWA) was previously reported to be associated with the early detection of disseminated intravascular coagulation and was also reported to be able to measure very low levels of coagulation factor VIII activity. The software program for the analysis for the APTT-CWA allows the associated first and second derivative curves (first and second DCs) to be displayed. The first and second DC reflect the velocity and acceleration, respectively. The height of the first DC reflects the “thrombin burst” and bleeding risk, while that of the second DC is useful for detecting any coagulation factor deficiency and abnormal enhancement of coagulation by phospholipids. Activated partial thromboplastin time-CWA aids in making a differential diagnosis which is difficult to do using only the routine APTT. The CWA is currently used for many applications in the clinical setting, including the monitoring of hemophilia patients and patients receiving anticoagulant therapy and the differential diagnosis of diseases.

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“…Many previous reports have discussed the clinical application of CWA in patients with disseminated intravascular coagulation, [27][28][29] and recently, the use of CWA for evaluating the anticoagulant effects of direct oral anticoagulants has been described. 30,31 Unlike previous reports, the current report employed a unique approach to CWA including no smoothing procedure and template matching that uses whole multiple parameters instead of a few selected parameters. To our best knowledge, this is the first report which applying a concept of template matching to CWA.…”

Section: Thrombosis and Haemostasismentioning

confidence: 99%

A Novel Assessment of Factor VIII Activity by Template Matching Utilizing Weighted Average Parameters from Comprehensive Clot Waveform Analysis

et al. 2020

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Background Activated partial thromboplastin time (aPTT)-based clot waveform analysis is used to evaluate the comprehensive dynamics of fibrin clot formation. In addition, the technique can be usefully utilized for the rapid assessment of factor (F)VIII procoagulant activity in various clinical settings in patients with hemophilia A (HA). We defined a novel algorithm based on the weighted average parameters from aPTT-based waveforms to devise a template-matching procedure for assessing FVIII activity (FVIII:C). Methods The first derivatives of original clot waveforms triggered by the aPTT reagent (Coagpia APTT-N) were used to determine weighted averages of areas surrounded by the waveform at different percentages of maximum height in various clotting factor-deficient plasmas. Prepared templates based on 50 weighted average-related parameters were compared with 78 aPTT-prolonged plasmas. Results Original nonsmoothed waveforms of the various clotting factor-deficient plasmas with prolonged aPTTs demonstrated a variety of shapes. The weighted averages were calculated after adjustments for different baselines, and the patterns seemed to be governed by the specific clotting factor deficiency. The weighted average-related parameters including baseline wedge (r 2 = 0.998) and aspect ratio (r 2 = 0.998) were highly correlated with FVIII:C levels. Template-matching analyses based on weighted average-related waveform parameters obtained from 158 samples demonstrated that the sensitivity was 97.2% and specificity was 83.3% in aPTT-prolonged plasmas (n = 78). Conclusion This novel algorithm based on weighted averages of aPTT-based waveforms together with template-matching may support clinical usefulness for judging of HA and may aid clinical management in the patients in the absence of specific clotting factor assays.

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Monitoring of hemostatic abnormalities in major orthopedic surgery patients treated with edoxaban by APTT waveform

Abstract: Introduction: An analysis of the activated partial thromboplastin time (APTT) in major

Cited by 16 publications

References 21 publications

Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk

Usefulness of the APTT waveform for the diagnosis of DIC and prediction of the outcome or bleeding risk

Update on the Clot Waveform Analysis

A Novel Assessment of Factor VIII Activity by Template Matching Utilizing Weighted Average Parameters from Comprehensive Clot Waveform Analysis

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