Clinical application study of clot waveform analysis of activated partial thromboplastin time in discriminating between hemophilia A and lupus anticoagulant-positive patients
Objective Clot waveform analysis(CWA)of activated partial thromboplastin time(APTT)was used to rapidly identify patients with hemophilia A(HA)and lupus anticoagulant(LA)positive,and to explore the diagnostic efficacy of APTT-CWA in HA and LA-positive patients.Methods From July 25,2022,to December 28,2023,145 patients with APTT prolongation were admitted to the First Hospital of Jilin University.This group comprised 106 males and 39 females,with an average age of(29.3±15.8)years,among whom there were 94 clinically confirmed HA cases and 51 LA-positive cases.The retrospective analysis employed the Mann-Whitney U test to compare APTT results and CWA parameters between HA patients and LA-positive individuals.CWA parameters including the first derivative of maximum reaction velocity(|min1|),the second derivative of maximum acceleration(|min2|),and maximum deceleration(|max2|)were investigated.Patients were classified based on the duration of APTT prolongation into mild(33 s＜APTT≤43 s),moderate(43 s＜APTT≤53 s),and severe(APTT＞53 s)groups.A comparison of APTT seconds and CWA parameters|min1|,|min2|,and|max2|was conducted for HA and LA-positive patients between each group.Furthermore,receiver operating characteristic(ROC)curves and area under the curve(AUC)were utilized to assess the diagnostic efficacy of CWA parameters and determine cut-off values.Results The APTT results for HA and LA-positive patients were 70.2 s and 41.5 s,respectively,exhibiting a statistically significant difference(P＜0.001).CWA parameters|min1|were 1.459％/s vs 3.868％/s,|min2|were 0.124％/s2 vs 0.502％/s2,and|max2|were 0.054％/s2 vs 0.388％/s2in HA and LA patients,respectively(P＜0.001).In all APTT prolongation groups,the CWA parameters|min1|,|min2|and|max2|for HA were significantly lower than those for LA-positive patients(P＜0.05).CWA graph analysis revealed that the peak heights of|min1|,|min2|,and|max2|in HA were lower compared to LA patients.In the severe extension group,HA displayed significantly decreased peak values and a flatter,incomplete curve.ROC curve analysis indicated AUC values were greater than 0.8(P＜0.01)for|min1|,|min2|,and|max2|in all APTT prolongation groups.Cut-off values for|min1|,|min2|,and|max2|were established for each prolongation group:mild(3.205％/s,0.423％/s2,and 0.300％/s2),moderate(2.884％/s,0.340％/s2,0.231％/s2),and severe(2.209％/s,0.190％/s2,0.095％/s2).Conclusion When APTT was extended within the same range,there were significant differences in CWA parameters between HA patients and LA patients,ROC curve analysis demonstrated the effectiveness of CWA parameters in distinguishing HA from LA-positive patients,APTT-CWA can serve as a low-cost,efficient,and specific method for the rapid identification of hemophilia and lupus anticoagulant-positive patients.
万方数据
维普
