ABSTRACT
The activated partial thromboplastin time (APTT) is the most common coagulation test
procedure performed in routine laboratories, apart from the prothrombin time. The
test is traditionally used for identifying quantitative and qualitative abnormalities
in the intrinsic and common pathways of coagulation, monitoring anticoagulant therapy
with unfractionated heparin, and detecting inhibitors of blood coagulation, the most
common of which is the lupus anticoagulant. Whereas short APTT values have been mostly
overlooked in the past, recent evidence suggests that these might be associated with
hypercoagulability. Although clinical relevance is yet to be clearly defined, hypercoagulability
detected by a shortened APTT appears to be significantly associated with a major risk
of venous thromboembolism independently from other variables such as blood group,
the presence of inherited thrombophilia, and factor VIII levels. This novel finding
suggests that this traditional, simple, and inexpensive test might have renewed utility
along with traditional thrombophilic tests in the evaluation of venous thromboembolic
risk. In addition, APTT waveform analysis is also providing mounting evidence of added
utility, in particular for identifying sepsis and disseminated intravascular coagulation
in critically ill patients (particularly where this might worsen the prognosis), for
monitoring therapy in patients with inhibitors, and as a diagnostic aid to identify
patients with antiphospholipid antibodies. In total, such emerging evidence suggests
that the APTT is either an old dogma displaying new tricks or else might describe
a new dogma for an old laboratory trick.
KEYWORDS
Activated partial thromboplastin time - clotting assay - factor V - hemophilia - therapy
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Prof. Giuseppe LippiM.D.
Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università
degli Studi di Verona
Ospedale Policlinico G.B. Rossi, Piazzale Scuro, 10 37134 – Verona, Italy
Email: giuseppe.lippi@univr.it