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CC BY 4.0 · Semin Thromb Hemost
DOI: 10.1055/a-2778-9810
Review Article

Decoding Clot Waveform Analysis: Toward Better Understanding and Harmonization

Authors

  • Jing Yuan Tan   *

    1   Department of Haematology, Singapore General Hospital, Singapore

  • Marvin Raden Torres De Guzman    *

    1   Department of Haematology, Singapore General Hospital, Singapore

  • Wan Hui Wong

    1   Department of Haematology, Singapore General Hospital, Singapore

  • Chi Kiat Yeo

    1   Department of Haematology, Singapore General Hospital, Singapore

  • Guan Hao Goh

    1   Department of Haematology, Singapore General Hospital, Singapore

  • Heng Joo Ng

    1   Department of Haematology, Singapore General Hospital, Singapore

  • Chuen Wen Tan

    1   Department of Haematology, Singapore General Hospital, Singapore
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Abstract

Clot waveform analysis (CWA) extends routine coagulation assays (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) by incorporating continuous optical monitoring to generate kinetic profiles of clot formation. This method provides both qualitative and quantitative information on hemostasis, with increasing evidence for its clinical utility in detecting factor deficiencies and characterizing thrombotic and bleeding disorders. Despite the growing body of evidence, translation of CWA into routine clinical practice remains limited.

This review identifies three principal barriers: (1) variability arising from differences in optical detection methods (absorbance vs. transmittance), (2) interreagent variation even within the same analyzer platform, and (3) lack of a clear distinction between standard CWA, performed with commercially available reagents, and modified CWA, incorporating in-house adjustments. To address these challenges, we encourage adopting distinct nomenclature for detection modalities (CWA-A; A for absorbance and CWA-T; T for transmittance), establishing standardized reporting requirements including reagent and platform details, and establishing quality assurance frameworks for CWA.

Standardization of terminology and reporting will enhance reproducibility, enable cross-study comparisons, and accelerate the clinical translation of CWA from the laboratory bench to the bedside.

Keywords

coagulation - standardization - hemostasis - clot waveform analysis

Authors' Contributions

J.Y.T., M.R.T.D.G., and C.W.T. contributed to the original draft and manuscript revision. W.H.W., C.K.Y., G.H.G., and H.J.N. contributed to manuscript revision.


* These authors contributed equally and share primary co-authorship of this article.




Publication History

Received: 06 October 2025

Accepted: 23 December 2025

Accepted Manuscript online:
08 January 2026

Article published online:
21 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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