Abstract
Acquired coagulation defects are characterized by a decrease of both pro- and anti-coagulants. Because of this, we hypothesise that global tests, such as the prothrombin and partial thromboplastin times (PT and APTT), might be unsuitable for their investigation. Indeed, these tests are not good predictors of bleeding in acquired coagulopathies as they are in the congenital ones. This article discusses the possible reasons for this, using cirrhosis and the neonatal period as epitomes of acquired coagulation defects. Both display normal thrombin generation in the presence of thrombomodulin, in spite of prolonged PT and APTT. We surmise that, because of their design, the PT and APTT are responsive to thrombin generated as a function of pro-coagulants, but much less to thrombin inhibited by the anti-coagulants, especially protein C, which is activated to a limited extent in the absence of thrombomodulin. In conclusion, the PT and APTT can tell us whether or not a patient is deficient in one or more pro-coagulants, but not whether this deficiency is counterbalanced by a parallel deficiency of anti-coagulants. Thrombin generation assays are more suitable than PT and APTT for use in acquired coagulation defects.
| Original language | English |
|---|---|
| Pages (from-to) | 77-82 |
| Number of pages | 6 |
| Journal | British Journal of Haematology |
| Volume | 147 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Oct 2009 |
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Keywords
- Bleeding disorders
- Coagulation factors
- Liver disease
- Neonatal haematology
- Thrombin
ASJC Scopus subject areas
- Hematology
Cite this
Acquired coagulation disorders : Revisited using global coagulation/ anticoagulation testing. / Tripodi, Armando; Chantarangkul, Veena; Mannucci, Pier M.
In: British Journal of Haematology, Vol. 147, No. 1, 10.2009, p. 77-82.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Acquired coagulation disorders
T2 - Revisited using global coagulation/ anticoagulation testing
AU - Tripodi, Armando
AU - Chantarangkul, Veena
AU - Mannucci, Pier M.
PY - 2009/10
Y1 - 2009/10
N2 - Acquired coagulation defects are characterized by a decrease of both pro- and anti-coagulants. Because of this, we hypothesise that global tests, such as the prothrombin and partial thromboplastin times (PT and APTT), might be unsuitable for their investigation. Indeed, these tests are not good predictors of bleeding in acquired coagulopathies as they are in the congenital ones. This article discusses the possible reasons for this, using cirrhosis and the neonatal period as epitomes of acquired coagulation defects. Both display normal thrombin generation in the presence of thrombomodulin, in spite of prolonged PT and APTT. We surmise that, because of their design, the PT and APTT are responsive to thrombin generated as a function of pro-coagulants, but much less to thrombin inhibited by the anti-coagulants, especially protein C, which is activated to a limited extent in the absence of thrombomodulin. In conclusion, the PT and APTT can tell us whether or not a patient is deficient in one or more pro-coagulants, but not whether this deficiency is counterbalanced by a parallel deficiency of anti-coagulants. Thrombin generation assays are more suitable than PT and APTT for use in acquired coagulation defects.
AB - Acquired coagulation defects are characterized by a decrease of both pro- and anti-coagulants. Because of this, we hypothesise that global tests, such as the prothrombin and partial thromboplastin times (PT and APTT), might be unsuitable for their investigation. Indeed, these tests are not good predictors of bleeding in acquired coagulopathies as they are in the congenital ones. This article discusses the possible reasons for this, using cirrhosis and the neonatal period as epitomes of acquired coagulation defects. Both display normal thrombin generation in the presence of thrombomodulin, in spite of prolonged PT and APTT. We surmise that, because of their design, the PT and APTT are responsive to thrombin generated as a function of pro-coagulants, but much less to thrombin inhibited by the anti-coagulants, especially protein C, which is activated to a limited extent in the absence of thrombomodulin. In conclusion, the PT and APTT can tell us whether or not a patient is deficient in one or more pro-coagulants, but not whether this deficiency is counterbalanced by a parallel deficiency of anti-coagulants. Thrombin generation assays are more suitable than PT and APTT for use in acquired coagulation defects.
KW - Bleeding disorders
KW - Coagulation factors
KW - Liver disease
KW - Neonatal haematology
KW - Thrombin
UR - http://www.scopus.com/inward/record.url?scp=70349194473&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349194473&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2141.2009.07833.x
DO - 10.1111/j.1365-2141.2009.07833.x
M3 - Article
C2 - 19659548
AN - SCOPUS:70349194473
VL - 147
SP - 77
EP - 82
JO - British Journal of Haematology
JF - British Journal of Haematology
SN - 0007-1048
IS - 1
ER -