Clot waveform analysis for perioperative hemostatic monitoring in a hemophilia A patient on emicizumab undergoing liver transplantation.

Abstract

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.

• Authors: Mai Awane, Masatoshi Wakui, Yuko Ozaki, Yoshino Kondo, Shusaku Oka, Yuta Fujimori, Yoko Yatabe, Tomoko Arai, Yohei Yamada, Shutaro Hori, Hideaki Obara, Yasushi Hasegawa, Hiromichi Matsushita
• Journal: Clinica chimica acta; international journal of clinical chemistry (Clin Chim Acta) Vol. 544 Pg. 117339 (Apr 01 2023) ISSN: 1873-3492 [Electronic] Netherlands
• PMID: 37076096 (Publication Type: Case Reports)
• Copyright: Copyright © 2023 Elsevier B.V. All rights reserved.

Chemical References

• Hemostatics
• emicizumab
• Antibodies, Bispecific

Topics

• Humans
• Hemophilia A (drug therapy)
• Hemostatics
• Liver Transplantation
• Hemostasis
• Antibodies, Bispecific (therapeutic use)
• Thrombosis (drug therapy)