Clot-fibrinolysis waveform analysis (CFWA) enables the simultaneous assessment of coagulation and fibrinolytic functions within a short timeframe. We evaluated the effects of commonly used anticoagulants on coagulation–fibrinolysis balance using CFWA in anticoagulant-supplemented model plasma and explored its potential clinical application during extracorporeal circulation. Nafamostat mesylate (NM), unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH) were added to normal plasma to establish each model. Coagulation function was assessed using clotting time (CT) and maximum clotting velocity (min1), whereas fibrinolytic function was evaluated using fibrinolysis onset time (FLT) and total fibrinolysis (EFP).

Increasing NM concentrations prolonged CT and reduced min1 while prolonging FLT and decreasing EFP, indicating suppression of both coagulation and fibrinolysis. UFH prolonged CT and reduced min1 but shortened FLT and increased EFP, suggesting enhanced fibrinolytic susceptibility. LMWH produced milder anticoagulant effects with minimal influence on fibrinolytic parameters.

As an exploratory clinical application, CFWA was applied to a patient undergoing hemodialysis with suspected heparin resistance and recurrent circuit clotting. CFWA detected persistent hypercoagulability despite prolonged APTT after high-dose UFH administration, providing additional functional information not captured by conventional coagulation tests.

CFWA may provide a sensitive and comprehensive assessment of coagulation–fibrinolysis balance and serve as a complementary monitoring tool during extracorporeal circulation.