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CME Evaluation

Oral Communication Session

Diagnostics, OMICs and Advanced Technologies

Session: Methods for laboratory monitoring of hemostatic agents

OC 57.4 - Using clot-fibrinolysis waveform analysis to assessment both anticoagulant and antifibrinolytic effects of nafamostat mesylate in vitro

Tuesday, June 25, 2024
10:15 – 10:30 ICT
Room: 210 A-D

    Presenting Author(s)

  • Zhaoming Tang, MD

    Director of the Clinical Hemostasis and Thrombosis Laboratory
    Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
    Wuhan, Hubei, China (People's Republic)

    • Co-Author(s)

  • ZL

    Zekai Lin

    Technologist
    Department of Clinical Laboratory, Wuhan Union Hospital
    Wuhan, Hubei, China (People's Republic)

  • LW

    Lin Wang

    Director of the Clinical Laboratory
    Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
    Wuhan, Hubei, China (People's Republic)

Background:

Background: Nafamostat mesylate is a serine protease inhibitor and is clinically used increasingly. Although it is used as an anticoagulant, it can inhibit both thrombin and plasmin. Currently, there is no approved laboratory test to monitor both the anticoagulant and antifibrinolytic effects of nafamostat mesylate. Clot-fibrinolysis waveform analysis (CFWA) is a newly introduced method that can examine both coagulant and fibrinolytic functions.

Aims: To characterize the ability of CFWA to assess both anticoagulant and antifibrinolytic effects of nafamostat mesylate.

Methods: Pooled Normal Plasma (PNP) was spiked with nafamostat mesylate over the range of 50 – 1000 ng/mL. CFWA was performed and compared with activated partial thromboplastine time (APTT), thrombin generation assay (TGA), and plasmin generation assay (PGA). The linear regression analysis was used to examine the relationship between CFWA parameters and nafamostat mesylate concentration. Pearson's relationship was used to evaluate the correlation between tested parameters.

Results: The CFWA parameter Clot time and Lysis time were prolonged along with the increasing of nafamostat mesylate concentration (R2 = 0.991, p < 0.0001; R2 = 0.983, p < 0.0001 respectively). Clot time was correlated with APTT (r = 0.998, p < 0.0001). TGA had no signal when nafamostat mesylate concentration was above 200 ng/mL and was not compared with CFWA. The Lysis time of CFWA was correlated with PGA lag time (r = 0.994, p < 0.0001). The Clot time/Lysis time ratio increased with the increase of nafamostat mesylate concentration. Intriguingly, This ratio reached a plateau phase when nafamostat mesylate was above 500 ng/mL (figure 1).

Conclusion(s): This study showed a strong correlation between CFWA parameters (Clot time and Lysis time) and nafamostat mesylate concentration. These findings suggest CFWA could be an ideal candidate for monitoring the anticoagulant and antifibrinolytic effects of nafamostat mesylate.