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Although amilizumab is a bispecific monoclonal antibody that significantly improves the treatment of patients with hemophilia A treated with inhibitors, routine monitoring of patients treated with imizumab is difficult
.
Thrombin time (TT) reflects thrombin bursts
and depends mainly on the activation of factors V (FV) and FVIII.
Therefore, a research team developed a method
to assess coagulation activity independently of the presence of imizumab.
Partial thromboplastin time (APTT) and TT activated by clot waveform analysis (CWA) were used to measure normal plasma (NP) or FVIII-deficient plasma (FVIIIDP) with and without amilizumab
.
The results suggest that the use of CWA-APTT causes clot formation of emicizumab in FVIIIIDP; However, there was no statistically significant difference
between plasma clotting peaks measured by CWA-TT with and without amizumab.
Regarding the pooled test for NP and FVIIIIDP, CWA-APTT showed a larger mixed test in plasma with and without amizumab, while CWA-TT showed a similar pattern
in plasma mixed with and without amizumab.
Regarding the standard curve of FVIII activity, CWA-APTT showed a concentration-dependent increase in FVIII; However, FVIII values for each concentration differed between samples with and without amilizumab, while CWA-TT showed FVIII concentration-dependent fluctuations independent of the presence of amilizumab, and FVIII values for each concentration were similar
in samples with and without amilizumab.
Overall, it is thought that since CWA-TT with a small amount of thrombin (0.
5 IU/mL) reflects thrombin bursts and can be used to assess FVIII activity, it is independent of the presence of imizumab and can be used to monitor coagulation activity in patients with anti-FVIII inhibitors receiving imizumab
Original source:
Wada H, Shiraki K, Matsumoto T, Suzuki K, Yamashita Y, Tawara I, Shimpo H, Shimaoka M.
A Clot Waveform Analysis of Thrombin Time Using a Small Amount of Thrombin Is Useful for Evaluating the Clotting Activity of Plasma Independent of the Presence of Emicizumab.
J Clin Med.
2022 Oct 18; 11(20):6142.
doi: 10.
3390/jcm11206142.
PMID: 36294464; PMCID: PMC9605059.
