Clin Chem Lab Med 2017; aop Maria Filomena Ruberto, Francesco Marongiu*, Antonella Mandas, Antonella Mameli, Mariagrazia Porru, Elisabetta Cianchetti and Doris Barcellona The venous thromboembolic risk and the clot wave analysis: a useful relationship? https://doi.org/10.1515/cclm-2017-0678 Received July 30, 2017; accepted September 12, 2017 Abstract Background: Hospitalized patients with acute medical conditions have higher venous thromboembolism (VTE) risk. A patient with a final Padua Prediction Score (PPS) of ≥4 is considered to be at high risk for VTE. The aim of this study was to investigate on a possible relationship between PPS, the dynamics of the clot formation, i.e. the clot waveform analysis (CWA) of aPTT, fibrinogen and D-Dimer in a large group of medical patients. Methods: CWA in terms of velocity (first derivative), accelera- tion (second derivative), density (Delta) of aPTT, fibrinogen, D-Dimer and PPS for VTE were determined in 801 medical patients divided in three groups (without antithrombotic prophylaxis and high PPS, without antithrombotic prophy- laxis and low PPS, with antithrombotic prophylaxis and high PPS) and a group of healthy subjects. Results: CWA, fibrinogen and D-Dimer values were higher in the medical patients with high PPS with or without antithrombotic prophylaxis when compared with patients without antithrombotic prophylaxis with low PPS and healthy subjects. The second derivative, fibrinogen and D-Dimer were significantly associated with a high PPS score (≥4): odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.03–2.28; OR = 1.91, 95% CI = 1.3–2.79; OR = 3.16, 95% CI = 2.29–4.36, respectively. Interactions between first derivative and D-Dimer (OR = 2.14, 95% CI = 1.23–3.72) and first derivative and fibrinogen (OR = 1.75, 95% CI = 1.02– 2.98) were found. Conclusions: CWA could give useful information to rec- ognize a hypercoagulable state in patients admitted to a medical ward with high and low PPS. First and second derivative aPTT, D-Dimer and fibrinogen levels could be added to PPS to better assess the global thromboembolic risk of these patients. Keywords: aPTT derivatives; clot wave analysis; D-Dimer; fibrinogen; internal medicine ward; Padua Prediction Score. Introduction Hospitalized patients for an acute medical illness have about an eightfold increase in relative risk of developing venous thromboembolism (VTE) [1], with possible serious consequences. It is therefore necessary to identify those patients at risk for preventing VTE by means of an appro- priate prophylaxis as recommended in 2012 by the Ameri- can College of Chest Physicians [2]. These guidelines recommend the use of a score for the assessment of the risk factors for VTE: the Padua Prediction Score (PPS) [3]. This risk assessment model includes several risk factors for VTE to classify patients with a final score of ≥4, which indicates a high VTE risk and thus helpful for the begin- ning of an antithrombotic prophylaxis with anticoagu- lants. The aim of this study was to investigate on a possible relationship between a high PPS and a hypercoagulable state detected in patients admitted to our Internal Medi- cine Unit. For this purpose, we investigated the dynamics of the formation of fibrin, i.e. the clot waveform analysis (CWA) of aPTT, in terms of density (Delta), velocity (first derivative aPTT), acceleration (second derivative aPTT) together with fibrinogen and D-Dimer levels. The CWA technique was described first by Braun et al. [4] in 1997. CWA is available by means of an automated coagulometer using an implemented software [5]. This topic has been the subject of an official communication by the subcom- mittees of the International Society of Thrombosis and Haemostasis (ISTH) aimed at the standardization of CWA and the recommendations for its clinical application and research [6]. We analyzed these “hidden” parameters of aPTT in hospitalized medical patients with high and low PPS with and without anti-thrombotic prophylaxis and in a control group formed by healthy subjects. *Corresponding author: Prof. Francesco Marongiu, Internal Medicine and Haemostasis and Thrombosis Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy, Phone: +39070 6754188, E-mail: marongiu@medicina.unica.it Maria Filomena Ruberto, Antonella Mandas, Antonella Mameli, Mariagrazia Porru, Elisabetta Cianchetti and Doris Barcellona: Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy Brought to you by | University of Gothenburg Authenticated Download Date | 10/17/17 5:05 PM