TY - JOUR
T1 - Clot waveform analysis for perioperative hemostatic monitoring in a hemophilia A patient on emicizumab undergoing liver transplantation
AU - Awane, Mai
AU - Wakui, Masatoshi
AU - Ozaki, Yuko
AU - Kondo, Yoshino
AU - Oka, Shusaku
AU - Fujimori, Yuta
AU - Yatabe, Yoko
AU - Arai, Tomoko
AU - Yamada, Yohei
AU - Hori, Shutaro
AU - Obara, Hideaki
AU - Hasegawa, Yasushi
AU - Matsushita, Hiromichi
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - How to optimize perioperative factor VIII (FVIII) replacement through hemostatic monitoring is critically important to manage hemophilia A patients. The bispecific antibody emicizumab binds activated FIX (FIXa) and FX to functionally mimic FVIIIa. While being used for hemostatic control in hemophilia A, this therapeutic antibody inconveniently interferes with coagulation tests using human FIXa and FX, such as activated partial thromboplastin time (APTT) and FVIII activity measurement based on one-stage clotting assays. Clot waveform analysis (CWA) extends the interpretation of measurement curves for coagulation time to provide global information. We performed APTT-CWA to monitor perioperative hemostasis in a hemophilia A patient on emicizumab undergoing liver transplantation. Plasma samples were treated with anti-idiotype monoclonal antibodies against emicizumab to enable accurate coagulation assays. Kinetics of maximum coagulation velocity and acceleration mimicked that of FVIII activity. These CWA parameters better correlated with FVIII activity than APTT. The plateaus of them were observed at FVIII activity of 100% or more, supporting the protocol for perioperative FVIII replacement. Thus, CWA may measure coagulation potential in hemophilia A patients undergoing liver transplantation, aiding in optimizing perioperative hemostasis.
AB - How to optimize perioperative factor VIII (FVIII) replacement through hemostatic monitoring is critically important to manage hemophilia A patients. The bispecific antibody emicizumab binds activated FIX (FIXa) and FX to functionally mimic FVIIIa. While being used for hemostatic control in hemophilia A, this therapeutic antibody inconveniently interferes with coagulation tests using human FIXa and FX, such as activated partial thromboplastin time (APTT) and FVIII activity measurement based on one-stage clotting assays. Clot waveform analysis (CWA) extends the interpretation of measurement curves for coagulation time to provide global information. We performed APTT-CWA to monitor perioperative hemostasis in a hemophilia A patient on emicizumab undergoing liver transplantation. Plasma samples were treated with anti-idiotype monoclonal antibodies against emicizumab to enable accurate coagulation assays. Kinetics of maximum coagulation velocity and acceleration mimicked that of FVIII activity. These CWA parameters better correlated with FVIII activity than APTT. The plateaus of them were observed at FVIII activity of 100% or more, supporting the protocol for perioperative FVIII replacement. Thus, CWA may measure coagulation potential in hemophilia A patients undergoing liver transplantation, aiding in optimizing perioperative hemostasis.
KW - Clot waveform analysis
KW - Emicizumab
KW - Hemophilia A
KW - Liver transplantation
KW - Perioperative hemostasis
UR - http://www.scopus.com/inward/record.url?scp=85152734185&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85152734185&partnerID=8YFLogxK
U2 - 10.1016/j.cca.2023.117339
DO - 10.1016/j.cca.2023.117339
M3 - Article
C2 - 37076096
AN - SCOPUS:85152734185
SN - 0009-8981
VL - 544
JO - Clinica Chimica Acta
JF - Clinica Chimica Acta
M1 - 117339
ER -