Integrating biomarkers for hemostatic disorders into computational models of blood clot formation: A systematic review

Abstract

<p>In the pursuit of personalized medicine, there is a growing demand for computational models with parameters that are easily obtainable to accelerate the development of potential solutions. Blood tests, owing to their affordability, accessibility, and routine use in healthcare, offer valuable biomarkers for assessing hemostatic balance in thrombotic and bleeding disorders. Incorporating these biomarkers into computational models of blood coagulation is crucial for creating patient-specific models, which allow for the analysis of the influence of these biomarkers on clot formation. This systematic review aims to examine how clinically relevant biomarkers are integrated into computational models of blood clot formation, thereby advancing discussions on integration methodologies, identifying current gaps, and recommending future research directions. A systematic review was conducted following the PRISMA protocol, focusing on ten clinically significant biomarkers associated with hemostatic disorders: D-dimer, fibrinogen, Von Willebrand factor, factor Ⅷ, P-selectin, prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin Ⅲ, protein C, and protein S. By utilizing this set of biomarkers, this review underscores their integration into computational models and emphasizes their integration in the context of venous thromboembolism and hemophilia. Eligibility criteria included mathematical models of thrombin generation, blood clotting, or fibrin formation under flow, incorporating at least one of these biomarkers. A total of 53 articles were included in this review. Results indicate that commonly used biomarkers such as D-dimer, PT, and APTT are rarely and superficially integrated into computational blood coagulation models. Additionally, the kinetic parameters governing the dynamics of blood clot formation demonstrated significant variability across studies, with discrepancies of up to 1, 000-fold. This review highlights a critical gap in the availability of computational models based on phenomenological or first-principles approaches that effectively incorporate affordable and routinely used clinical test results for predicting blood coagulation. This hinders the development of practical tools for clinical application, as current mathematical models often fail to consider precise, patient-specific values. This limitation is especially pronounced in patients with conditions such as hemophilia, protein C and S deficiencies, or antithrombin deficiency. Addressing these challenges by developing patient-specific models that account for kinetic variability is crucial for advancing personalized medicine in the field of hemostasis.</p>