Objective:To establish reference values for clot waveform analysis (CWA) and analyze their diagnostic efficacy in distinguishing acquired hemophilia A (AHA) and lupus anticoagulant (LA)-positive patients.Methods:Case-Control Study. A total of 391 healthy individuals(260 males and 131 females) with a mean age of 45.53±14.85 years were enrolled at Nanyang central Hospital between January 6, 2023 and October 10, 2024. Prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) were measured to establish reference ranges for the CWA parameters, including maximal reaction velocity (Min1), maximal reaction acceleration (Min2), and maximal reaction deceleration (Max2). A total of 158 definitively diagnosed AHA and LA-positive patients (mean age:42.46±14.83 years), including 34 AHA patients and 124 LA-positive patients, were recruited. The Mann Whitney U test was used to analyze the differences in the CWA parameters between the two groups. The diagnostic efficacy of CWA parameters in distinguishing AHA and LA-positive patients was evaluated using the area under the receiver operating characteristic(ROC) curve AUC and the cut-off values were calculated. Results:The reference values for PT-Min1, APTT-Min1, APTT-Min2, APTT-Max2, TT-Min1, TT-Min2, TT-Max2 were 203.41-516.89, 144.63-324.03, 526.46-1 190.03, -404.96±157.22, 159.17±60.34, 272.29-686.99, and -289.47--113.76, respectively. Compared with the CWA parameters in AHA patients, APTT-Max2 was significantly lower in LA-positive patients [-422.74(-577.50, -239.22) vs. -68.87(-92.85,30.28), Z=-7.43, P<0.01], while PT-Min1, APTT-Min1, APTT-Min2, TT-Min1, TT-Min2 were significantly elevated [287.01(188.03, 382.50) vs. 107.45(90.20, 151.39), 972.88(601.20, 1 351.19) vs. 229.10(118.38, 371.67), Z=6.68, 6.69, all P<0.01]. ROC analysis demonstrated the APTT-CWA parameter exhibited high diagnostic efficacy in patients with AHA (AUC>0.900 for both).Additionally, APTT-Min1 and APTT-Max2 were found to be useful in distinguishing between AHA patients and those with LA-positive status accompanied by APTT prolongation (AUC=0.660, 0.700, respectively). Conclusions:Reference values for CWA parameters were successfully established. The APTT-CWA is useful for differentiating between AHA and LA-positive patients and APTT-Max2 demonstrated a good diagnostic value in differentiating AHA patients from those with LA-positive status accompanied by APTT prolongation.

Objective:To establish reference values for clot waveform analysis (CWA) and analyze their diagnostic efficacy in distinguishing acquired hemophilia A (AHA) and lupus anticoagulant (LA)-positive patients.Methods:Case-Control Study. A total of 391 healthy individuals(260 males and 131 females) with a mean age of 45.53±14.85 years were enrolled at Nanyang central Hospital between January 6, 2023 and October 10, 2024. Prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) were measured to establish reference ranges for the CWA parameters, including maximal reaction velocity (Min1), maximal reaction acceleration (Min2), and maximal reaction deceleration (Max2). A total of 158 definitively diagnosed AHA and LA-positive patients (mean age:42.46±14.83 years), including 34 AHA patients and 124 LA-positive patients, were recruited. The Mann Whitney U test was used to analyze the differences in the CWA parameters between the two groups. The diagnostic efficacy of CWA parameters in distinguishing AHA and LA-positive patients was evaluated using the area under the receiver operating characteristic(ROC) curve AUC and the cut-off values were calculated. Results:The reference values for PT-Min1, APTT-Min1, APTT-Min2, APTT-Max2, TT-Min1, TT-Min2, TT-Max2 were 203.41-516.89, 144.63-324.03, 526.46-1 190.03, -404.96±157.22, 159.17±60.34, 272.29-686.99, and -289.47--113.76, respectively. Compared with the CWA parameters in AHA patients, APTT-Max2 was significantly lower in LA-positive patients [-422.74(-577.50, -239.22) vs. -68.87(-92.85,30.28), Z=-7.43, P<0.01], while PT-Min1, APTT-Min1, APTT-Min2, TT-Min1, TT-Min2 were significantly elevated [287.01(188.03, 382.50) vs. 107.45(90.20, 151.39), 972.88(601.20, 1 351.19) vs. 229.10(118.38, 371.67), Z=6.68, 6.69, all P<0.01]. ROC analysis demonstrated the APTT-CWA parameter exhibited high diagnostic efficacy in patients with AHA (AUC>0.900 for both).Additionally, APTT-Min1 and APTT-Max2 were found to be useful in distinguishing between AHA patients and those with LA-positive status accompanied by APTT prolongation (AUC=0.660, 0.700, respectively). Conclusions:Reference values for CWA parameters were successfully established. The APTT-CWA is useful for differentiating between AHA and LA-positive patients and APTT-Max2 demonstrated a good diagnostic value in differentiating AHA patients from those with LA-positive status accompanied by APTT prolongation.

【Objective】 To explore the value of thromboelastogram (TEG) in evaluating coagulation function of patients with liver cancer. 【Methods】 102 patients with liver cancer and 48 with hepatic hemangioma from Department of Hepatobiliary Surgery, Nanyang Central Hospital from August 2017 to September 2020 were retrospectively analyzed. TEG indicators (R, K, Angle, MA, CI, and G value) and routine coagulation indicators (Plt, PT, INR, APTT, FIB, and TT) of those patients and basic clinical data of liver cancer patients were collected, and the difference of detection parameters between the liver cancer group and liver hemangioma group was compared; The difference of TEG parameters in liver cancer patient subgroups was compared, and the correlation between TEG and routine coagulation tests in liver cancer patients was analyzed using Spearman rank correlation analysis. The sensitivity of the two detection methods in detecting the coagulation status of patients with liver cancer was compared. 【Results】 1) Compared with patients with hepatic hemangioma, Plts decreased significantly (166.6±108.824 vs 224.10±54.933, P<0.001), while PT, INR and APTT values increased significantly (13.12±2.052 vs 11.421±0.884, 1.156±0.191 vs 1.00±0.074, 29.977±5.333 vs 26.954±5.269, all P<0.05) in patients with liver cancer; MA and G values in patients with liver cancer were lower (56.991±11.574 vs 60.069±5.094, 7.667±4.682 vs 7.725±1.709, P<0.05); 2) Compared with newly diagnosed liver cancer patients, the Plt of re-diagnosed liver cancer patients decreased significantly(125.78±79.673 vs 188.86±116.437, P<0.05); the R and K value increased significantly (7.594±2.601 vs 6.058±1.739, 3.453±2.402 vs 2.438±1.990, all P<0.05), while the Angle, MA, CI and G value decreased significantly (53.897±12.288 vs 61.495±9.949, 53.556±11.407 vs 58.865±11.313, -3.494±4.253vs -0.836±3.180, 6.311±3.209 vs 8.406±5.191, all P<0.05); 3) There were significant differences in TEG parameters (R value excluded) between liver resection, transhepatic arterial chemoembolization and conservative treatment (P<0.05); 4) The R, K value of patients with liver cancer were negatively correlated with the Plt value, while the Angle, MA, CI, and G value were positively correlated with Plt value (P<0.001); the K value was negatively correlated with the Fib value, while the Angle, MA, CI, G value were positively correlated with Fib value (P<0.001); the R and K value were positively correlated with TT value, while the Angle and CI were negatively correlated with TT value (P<0.05); 5) The detection rate of hypocoagulability by TEG and routine coagulation testing was 18.63% (19/102) and 7.84%. 【Conclusion】 Compared with the newly diagnosed liver cancer patients, re-diagnosed liver cancer patients showed hypercoagulability. TEG can diagnose the coagulation abnormalties more sensitively, and help reduce the risk of bleeding.