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Archives of Pathology & Laboratory... Nov 2022A prolonged activated partial thromboplastin time (APTT), a vital screening test for coagulation, can be due to deficiencies in coagulation factors and the existence of...
CONTEXT.—
A prolonged activated partial thromboplastin time (APTT), a vital screening test for coagulation, can be due to deficiencies in coagulation factors and the existence of factor inhibitors or antiphospholipid antibodies. APTT mixing studies are being optimized to help find the cause.
OBJECTIVE.—
To optimize APTT mixing studies, we evaluated existing standards and explored when and how to combine 1:1 and 4:1 mixing.
DESIGN.—
Patients with a prolonged APTT but otherwise normal prothrombin time and thrombin time were enrolled in our hospital from January 1, 2018, to December 31, 2019. All samples were subjected to 1:1 mixing studies, while 134 were subjected to 4:1.
RESULTS.—
A total of 251 samples were involved, including 116 with factor deficiencies, 75 with FVIII inhibitors, and 60 with antiphospholipid antibodies. A Rosner index less than 11% or an extended incubation time of more than 3 seconds was better than other existing standards in differentiating factor deficiencies from inhibitors and in differentiating time-dependent inhibitors from time-independent inhibitors, but the approach presented here improves upon those. For the best diagnostic accuracy, samples with a Rosner index between 5.0% and 9.1% need a 4:1 mixing study, while others need 1:1. A combination of Rosner index and percent-extended incubation time-P seemed to offer objective and effective criteria for interpreting the results.
CONCLUSIONS.—
APTT mixing studies had overall good sensitivity and specificity in differentiating factor deficiencies from inhibitors, or time-dependent from time-independent inhibitors. The combination of 1:1 and 4:1 mixing studies can improve the diagnostic ability compared with 1:1 alone.
Topics: Humans; Partial Thromboplastin Time; Blood Coagulation Tests; Prothrombin Time; Blood Coagulation Factors; Blood Coagulation Disorders; Antibodies, Antiphospholipid; Thrombosis
PubMed: 35271692
DOI: 10.5858/arpa.2021-0123-OA -
Archives of Pathology & Laboratory... Nov 2021Specific reference intervals (RIs) facilitate accurate interpretation of results. Coagulation assay results may vary by demographics and also between reagents and... (Observational Study)
Observational Study
CONTEXT.—
Specific reference intervals (RIs) facilitate accurate interpretation of results. Coagulation assay results may vary by demographics and also between reagents and analyzers used. Current Thromboelastograph 6s (TEG 6s) Hemostasis Analyzer RIs were generated from adult samples.
OBJECTIVE.—
To generate reagent analyzer-specific pediatric RIs for TEG 6s and coagulation parameters.
DESIGN.—
A prospective, observational, single-center study of healthy children undergoing general anesthesia (January 3, 2017 to January 3, 2019). Venous blood samples were obtained for TEG 6s (Kaolin, Kaolin-Heparinase, Rapid and Functional Fibrinogen assays) and coagulation parameters (activated partial thromboplastin time, prothrombin time, thrombin clotting time, Echis time, antithrombin activity, and fibrinogen concentration using Instrumentation Laboratory ACL-TOP analyzers). Differences between activated partial thromboplastin time and prothrombin time reagents were investigated using mixed-effects regression, comparing maximum coefficients-of-variation with assay-specific allowable variation. RIs (lower/upper limits 2.5th of 97.5th percentiles) were generated using the following 2 methods: within discrete age-groups (neonates [<1 month], infants [1 month-1 year], young children [1-5 years], older children [6-10 years], and adolescents [11-16 years]), and modeled as functions of age and/or sex using quantile regression, including significant fractional polynomial and interaction terms.
RESULTS.—
Variation between prothrombin time and activated partial thromboplastin time assays using different reagents was clinically significant. Reagent-analyzer specific pediatric RIs were generated using data from 254 children. Discrete and model-based RIs varied by age for all coagulation parameters and TEG 6s variables in all assays.
CONCLUSIONS.—
We report reagent-analyzer specific pediatric RIs for TEG 6s and coagulation parameters. Observed variation reinforces recommendations for laboratory-specific RIs. These findings improve accuracy of interpretation of clinical results, provide a foundation for comparison and validation of tests in pathology, and illustrate feasibility and advantages of model-based RI approaches.
Topics: Adolescent; Age Factors; Anesthesia, General; Blood Coagulation; Child; Child, Preschool; Healthy Volunteers; Humans; Infant; Infant, Newborn; Models, Biological; Partial Thromboplastin Time; Predictive Value of Tests; Prospective Studies; Prothrombin Time; Reference Values; Reproducibility of Results; Thrombelastography
PubMed: 33503231
DOI: 10.5858/arpa.2020-0647-OA -
BioMed Research International 2021To evaluate the prognostic role of prothrombin time (PT) and activated partial thromboplastin time (APTT) for newly diagnosed multiple myeloma (MM).
PURPOSE
To evaluate the prognostic role of prothrombin time (PT) and activated partial thromboplastin time (APTT) for newly diagnosed multiple myeloma (MM).
METHODS
We retrospectively analyzed 354 patients with newly diagnosed MM who received primary treatment in our center. The propensity score matching technique was used to reduce the bias between groups.
RESULTS
Among 354 patients, lengthened PT or APTT was observed in 154 (43.5%) patients and 200 (56.5%) patients had normal PT and APTT. Patients with lengthened PT or APTT had significantly shorter median overall survival (OS) (37.5 vs. 73.8 months, < 0.001) and progression-free survival (PFS) (23.1 vs. 31.6 months, = 0.001) than those with normal PT and APTT. Univariate Cox proportional hazards regression analyses showed that lengthened PT or APTT was associated with shorter OS (HR = 2.100, 95% CI: 1.525-2.893, < 0.001). Lengthened PT or APTT was also a poor prognostic factor for OS (HR = 3.183, 95% CI: 1.803-5.617, < 0.001) in multivariable analyses. The poor effect of lengthened PT or APTT on PFS was confirmed in univariate analysis (HR = 1.715, 95% CI: 1.244-2.365, = 0.001), but it had no impact on PFS in multivariate analysis ( = 0.197). In the propensity score matching analysis, 154 patients, 77 in each group, were identified. Among 154 matched patients, the OS of patients with lengthened PT or APTT was shorter (38.4 vs. 51.0 months, = 0.030), but PFS was similar (29.0 vs. 35.0 months, = 0.248).
CONCLUSION
These results demonstrated that lengthened PT or APTT was an independent poor prognostic factor for patients with newly diagnosed MM.
Topics: Aged; Blood Coagulation; Blood Coagulation Tests; Female; Humans; Male; Multiple Myeloma; Partial Thromboplastin Time; Prognosis; Progression-Free Survival; Prothrombin Time; Retrospective Studies
PubMed: 34104651
DOI: 10.1155/2021/6689457 -
Molecules (Basel, Switzerland) Mar 2022Eight dipeptides containing antifibrinolytic agents (tranexamic acid, aminocaproic acid, 4-(aminomethyl)benzoic acid, and glycine-natural amino acids) were synthesized...
Eight dipeptides containing antifibrinolytic agents (tranexamic acid, aminocaproic acid, 4-(aminomethyl)benzoic acid, and glycine-natural amino acids) were synthesized in a three-step process with good or very good yields. DMT/NMM/TsO (4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium toluene-4-sulfonate) was used as a coupling reagent. Hemolysis tests were used to study the effects of the dipeptides on blood components. Blood plasma clotting tests were used to examine their effects on thrombin time (TT), prothrombin time (PT), and the activated partial thromboplastin time (aPTT). The level of hemolysis did not exceed 1%. In clotting tests, TT, PT, and aPTT did not differentiate any of the compounds. The prothrombin times for all amides - were similar. The obtained results in the presence of amides - and were slightly lower than for the other compounds and the positive control, and they were similar to the results obtained for TA. In the case of amide , a significantly decreased aPTT was observed. The aPTTs observed for plasma treated with amide and TA were comparable. In the case of amide and , TT values significantly lower than for the other compounds were found. The clot formation and fibrinolysis (CFF) assay was used to assess the influence of the dipeptides on the blood plasma coagulation cascade and the fibrinolytic efficiency of the blood plasma. In the clot formation and fibrinolysis assay, amides and were among the most active compounds. The cytotoxicity and genotoxicity of the synthesized dipeptides were evaluated on the monocyte/macrophage peripheral blood cell line. The dipeptides did not cause hemolysis at any concentrations. They exhibited no significant cytotoxic effect on SC cells and did not induce significant DNA damage.
Topics: Amides; Dipeptides; Hemolysis; Hemostasis; Hemostatics; Humans; Partial Thromboplastin Time; Prothrombin Time
PubMed: 35408669
DOI: 10.3390/molecules27072271 -
The Journal of International Medical... Jan 2022A high prevalence of venom-induced consumption coagulopathy has been reported in individuals with viper snakebites. Rotational thromboelastometry (ROTEM) is a rapid... (Observational Study)
Observational Study
BACKGROUND
A high prevalence of venom-induced consumption coagulopathy has been reported in individuals with viper snakebites. Rotational thromboelastometry (ROTEM) is a rapid technique that could be advantageous in assessing and monitoring coagulation disorders.
PURPOSE
To explore correlations between ROTEM and standard coagulation tests.
PATIENTS AND METHODS
This prospective observational study was performed among 41 patients with viper envenomation admitted to the Vietnam Poison Control Center from April 2016 to October 2017. Standard coagulation measurements [platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen level] and ROTEM indicators [clotting time (CT), amplitude (at set time: 5 and 10 minutes), clot information time (CFT) and maximum clot firmness (MCF) for extrinsic (EXTEM), intrinsic (INTEM), and fibrin based (FIBTEM) ROTEM] were obtained.
RESULTS
For INTEM, EXTEM, the FIBTEM, proportions of patients with prolonged CT were 34.1%, 63.4%, and 61.0% respectively and the proportions of patients with decreased MCF were 62.2%, 62.2%, and 35.5%, respectively. Moderate correlations were observed between PT and EXTEM CT (r = 0.627), aPTT and INTEM CT (r = 0.626), fibrinogen and FIBTEM MCF (r = 0.723), and platelet count and EXTEM MCF (0.60).
CONCLUSION
ROTEM indicated a hypocoagulation state in patients with viper snakebite and was moderately correlated with standard coagulation parameters.
Topics: Blood Coagulation Tests; Humans; Partial Thromboplastin Time; Prothrombin Time; Snake Bites; Thrombelastography
PubMed: 35023369
DOI: 10.1177/03000605211067321 -
The Medical Journal of Australia Sep 1998
Topics: Administration, Oral; Anticoagulants; Drug Administration Schedule; Humans; Prothrombin Time; Risk
PubMed: 9762055
DOI: 10.5694/j.1326-5377.1998.tb140241.x -
American Journal of Hematology Oct 2004The anticoagulant activity of warfarin sodium is monitored by the prothrombin time (PT) using the international normalized ratio (INR). Standard oral anticoagulant... (Review)
Review
The anticoagulant activity of warfarin sodium is monitored by the prothrombin time (PT) using the international normalized ratio (INR). Standard oral anticoagulant therapy monitoring requires frequent patient visits to physicians' offices and/or laboratories to optimize warfarin dosage. Home PT monitoring by patients can increase testing frequency and may thus decrease complications associated with oral anticoagulant therapy. Clinical studies suggest that home PT monitoring is more effective than uncoordinated management and is as effective as care through specialized anticoagulation clinics for keeping INRs within a therapeutic range. There are accurate and reliable instruments available, but paramount to the success of home PT monitoring is sound patient selection, appropriate patient training, and consistent quality control.
Topics: Anticoagulants; Drug Monitoring; Humans; International Normalized Ratio; Patient Education as Topic; Prothrombin Time; Self Care; Warfarin
PubMed: 15389909
DOI: 10.1002/ajh.20161 -
Medicina (Kaunas, Lithuania) Jun 2023Activated partial thromboplastin time (aPTT) is a fundamental screening test for coagulation disturbances. An increased aPTT ratio is quite common in clinical practice.... (Review)
Review
Activated partial thromboplastin time (aPTT) is a fundamental screening test for coagulation disturbances. An increased aPTT ratio is quite common in clinical practice. How the detection of prolonged activated aPTT with a normal prothrombin time is interpreted is therefore very important. In daily practice, the detection of this abnormality often leads to delayed surgery and emotional stress for patients and their families and may be associated with increased costs due to re-testing and coagulation factor assessment. An isolated, prolonged aPTT is seen in (a) patients with congenital or acquired deficiencies of specific coagulation factors, (b) patients receiving treatment with anticoagulants, mainly heparin, and (c) individuals/patients with circulating anticoagulants. We summarize here what may cause an isolated prolonged aPTT and evaluate the preanalytical interferences. The identification of the cause of an isolated prolonged aPTT is of the utmost importance in ensuring the correct diagnostic workup and therapeutic choices.
Topics: Humans; Partial Thromboplastin Time; Blood Coagulation Tests; Blood Coagulation; Prothrombin Time; Blood Coagulation Factors; Anticoagulants; Hemorrhage; Blood Coagulation Disorders
PubMed: 37374373
DOI: 10.3390/medicina59061169 -
BMC Pregnancy and Childbirth May 2024Preeclampsia (PE), an obstetric disorder, remains one of the leading causes of maternal and infant mortality worldwide. In individuals with PE, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preeclampsia (PE), an obstetric disorder, remains one of the leading causes of maternal and infant mortality worldwide. In individuals with PE, the coagulation-fibrinolytic system is believed to be among the most significantly impacted systems due to maternal inflammatory responses and immune dysfunction. Therefore, this systematic review and meta-analysis aimed to assess the association of prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) levels with preeclampsia.
METHODS
This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Articles relevant to the study, published from July 26, 2013, to July 26, 2023, were systematically searched across various databases including PubMed, Scopus, Embase, and Hinari. The methodological quality of the articles was evaluated using the Joanna Briggs Institute critical appraisal checklist. Utilizing Stata version 14.0, a random-effects model was employed to estimate the pooled standardized mean difference (SMD) along with the respective 95% CIs. The I statistics and Cochrane Q test were utilized to assess heterogeneity, while subgroup analyses were performed to explore its sources. Furthermore, Egger's regression test and funnel plot were employed to assess publication bias among the included studies.
RESULTS
A total of 30 articles, involving 5,964 individuals (2,883 with PE and 3,081 as normotensive pregnant mothers), were included in this study. The overall pooled SMD for PT, APTT, and TT between PE and normotensive pregnant mothers were 0.97 (95% CI: 0.65-1.29, p < 0.001), 1.05 (95% CI: 0.74-1.36, p < 0.001), and 0.30 (95% CI: -0.08-0.69, p = 0.11), respectively. The pooled SMD indicates a significant increase in PT and APTT levels among PE patients compared to normotensive pregnant mothers, while the increase in TT levels among PE patients was not statistically significant.
CONCLUSIONS
The meta-analysis underscores the association between PE and prolonged PT and APTT. This suggests that evaluating coagulation parameters like PT, APTT, and TT in pregnant women could offer easily accessible and cost-effective clinical indicators for assessing PE. However, multicenter longitudinal studies are needed to evaluate their effectiveness across various gestational weeks of pregnancy.
Topics: Humans; Pregnancy; Female; Pre-Eclampsia; Partial Thromboplastin Time; Prothrombin Time; Thrombin Time; Blood Coagulation
PubMed: 38741046
DOI: 10.1186/s12884-024-06543-7 -
Annals of Palliative Medicine Apr 2021To investigate the relationships of cancer antigen (CA) 125, CA 19-9, prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen...
BACKGROUND
To investigate the relationships of cancer antigen (CA) 125, CA 19-9, prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen (FIB), and D-dimer values with ovarian endometriosis (OEM), and to explore the validation of biomarkers for noninvasive preoperative evaluation of patients with severe OEM.
METHODS
This retrospective case-control study included 413 women with OEM (of whom 143 cases were stage I to II, 139 cases were stage III, and 131 cases were stage IV, respectively) and 158 women without OEM as controls. Subjects' serum CA-125 and CA19-9 levels, and coagulation test results (serum PT, aPTT, and D-dimer values) were evaluated.
RESULTS
The serum CA-125, aPTT, FIB and D-dimer levels were statistically different between OEM patients in the stages I to (and) II group and those in the stages III and IV group (P<0.05). However, a statistical difference in CA 19-9 levels and TT was only found between patients with stages III and IV OEM. In receiver operating characteristic (ROC) curve analysis of single indexes, the area under the ROC curve values for CA-125, CA19-9, aPTT, TT, FIB, and D-dimer were 0.953, 0.512, 0.66, 0.576, 0.573, and 0.624, respectively, for diagnosing stage III and stage IV OEM. In ROC curve analysis of combined indexes, the AUC values for aPTT + D-dimer, CA-125 + D-dimer, CA-125 + aPTT and CA-125 + D-dimer + aPTT were 0.672, 0.954, 0.958, and 0.961, respectively.
CONCLUSIONS
The combined index of CA-125, aPTT, and D-dimer is a valid noninvasive preoperative method for the evaluation of moderate and severe OEM, and may help to decrease the interval between the first complaint and a definitive diagnosis.
Topics: Case-Control Studies; Endometriosis; Female; Humans; Partial Thromboplastin Time; Prothrombin Time; Retrospective Studies
PubMed: 33966422
DOI: 10.21037/apm-21-481