Predictive value of APTT in patients under treatment with oral anticoagulants, conditioning the therapeutic approach to bleeding risk.
DOI:
https://doi.org/10.35954/SM2001.23.1.3Keywords:
Oral anticoagulation; APTT; INR; Bleeding.Abstract
The authors demonstrate the usefulness of the APTT in the assessment of bleeding risk in patients under treatment with oral anticoagulants, especially warfarin. A 3-month cohort study was conducted in patients (65% men and 35% women) under oral anticoagulation with warfarin at different doses. For this purpose, the results of the following homeostasis tests were compared: APTT, Ratio (R), Fibrinogen, Prothrombin time (PT), INR in two populations. The first consisted of 625 subjects under anticoagulant treatment in routine controls and the second consisted of 9 patients who presented hemorrhagic complications with and without decrease in the Prothrombin rate. The relationship between the results of these tests and the quantification of coagulant Factors II, VII and IX was also assessed in 23 patients.
For 95% of the patients presenting INR values between 2.0 and 3.0, the ratio values were between 0.9 and 1.7, which is considered a therapeutic range for patients in our population of anticoagulated patients. In 12% of the cases, values of R> 1.7 were verified despite the INR values being within the target range (2.3 and 3.0). For the patient population that presented bleeding, R>1.7 values were observed in all cases despite the fact that 50% of the cases were within the target INR (2.0 and 3.0). The decrease in factor IX and its detection by means of sensitive cephalin reagents suggests that the predictive value of the APTT is valuable as it is the only routine test that assesses it, whereas the Prothrombin Time does not. This test constitutes a fundamental tool in the evaluation of bleeding risk in patients on oral anticoagulants.
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