WM coagulation factors contribute robustly in a WB clotting assay. ROTEM measurements in WB samples from HDs (n = 31, blue), patients with WM not on therapy (n = 13, red) or receiving BTKis (n = 5, green). (A-C) INTEM is triggered by calcium, phospholipids, and ellagic acid. (D-F) EXTEM is triggered by calcium and tissue factor, whereas (G-I) FIBTEM additionally inhibits platelet cytoskeletal changes with cytochalasin D and reflects the coagulation factor contribution to thrombus formation. (J-K) EXTEM-FIBTEM (PLTEM) reflects the platelet contribution to thrombus formation. Mean ± SD. P values were determined by Kruskal-Wallis 1-way ANOVA with Dunn's multiple comparisons test. MCE, maximum clot elasticity (MCF × 100)/(100 − MCF); MCF, maximal clot firmness.