PMID- 30630206
OWN - NLM
STAT- MEDLINE
DCOM- 20190219
LR  - 20190320
IS  - 1098-9064 (Electronic)
IS  - 0094-6176 (Linking)
VI  - 45
IP  - 1
DP  - 2019 Feb
TI  - How to Optimize Activated Partial Thromboplastin Time (APTT) Testing: Solutions 
      to Establishing and Verifying Normal Reference Intervals and Assessing APTT 
      Reagents for Sensitivity to Heparin, Lupus Anticoagulant, and Clotting Factors.
PG  - 22-35
LID - 10.1055/s-0038-1677018 [doi]
AB  - The activated partial thromboplastin time (APTT) assay is a very common 
      coagulation test, used for several reasons. The test is conventionally used for 
      assessing the contact factor (intrinsic) pathway of blood coagulation, and thus 
      for screening deficiencies in this pathway, most typically factors VIII, IX, and 
      XI. The APTT is also sensitive to contact factor deficiencies, including factor 
      XII, prekallikrein, and high-molecular-weight kininogen. The APTT may also be 
      elevated in a variety of conditions, including liver disease, vitamin K 
      deficiency, and disseminated intravascular coagulation. The APTT can also be used 
      for monitoring unfractionated heparin (UFH) therapy, as well as for screening 
      lupus anticoagulant (LA) or for assessing thrombosis risk. Which of these 
      separate uses is important to a given laboratory or clinician depends on the 
      laboratory and the clinical context. For example, UFH sensitivity is important in 
      hospital-based laboratories, where UFH therapy is used, but not in hospital-based 
      laboratories where low-molecular-weight heparin (LMWH) is largely employed or 
      where UFH may be assessed by anti-factor Xa testing, or in private/community 
      laboratories not associated with a hospital system. High sensitivity to (low 
      levels of) factors VIII, IX, and XI is generally preferred, as their deficiencies 
      are clinically significant. Also preferred, but not usually achieved, is low 
      sensitivity to factor XII and other contact factors, as these deficiencies are 
      usually asymptomatic. Nevertheless, a good knowledge of factor sensitivity is 
      usually needed, if only to help explain the reasons for a prolonged APTT in a 
      given patient, or whether factor testing or other investigation is required. A 
      good working knowledge of reagents sensitivity to LA is also advisable, 
      especially when the reagent is used as part of a LA test panel, or else as a 
      "general-purpose screening reagent." The current report is aimed at providing 
      some guidance around these questions, and is intended as a kind of "how to" 
      guide, that will enable laboratories to assess APTT reagents in regard to their 
      sensitivity to heparin, LA, and clotting factors. The report also provides some 
      advice on generation of normal reference ranges, as well as solutions for 
      troubleshooting prolonged APTTs, when performing factor testing or searching for 
      inhibitors.
CI  - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
FAU - Favaloro, Emmanuel J
AU  - Favaloro EJ
AD  - Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of 
      Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead 
      Hospital, Westmead, New South Wales, Australia.
AD  - Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, 
      Australia.
FAU - Kershaw, Geoffrey
AU  - Kershaw G
AD  - Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, 
      Australia.
FAU - Mohammed, Soma
AU  - Mohammed S
AD  - Diagnostic Haemostasis Laboratory, Department of Haematology, Institute of 
      Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead 
      Hospital, Westmead, New South Wales, Australia.
FAU - Lippi, Giuseppe
AU  - Lippi G
AD  - Department of Haematology, NSW Health Pathology, Royal Prince Alfred Hospital, 
      Camperdown, New South Wales, Australia.
AD  - Section of Clinical Biochemistry, Department of Neurological, Biomedical and 
      Movement Sciences, University of Verona, Verona, Italy.
LA  - eng
PT  - Journal Article
DEP - 20190110
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Blood Coagulation Factors)
RN  - 0 (Lupus Coagulation Inhibitor)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Blood Coagulation Factors/*metabolism
MH  - Heparin/*metabolism
MH  - Humans
MH  - Lupus Coagulation Inhibitor/*blood
MH  - Partial Thromboplastin Time/*methods
MH  - Reference Values
COIS- None.
EDAT- 2019/01/11 06:00
MHDA- 2019/03/21 06:00
CRDT- 2019/01/11 06:00
PHST- 2019/01/11 06:00 [pubmed]
PHST- 2019/03/21 06:00 [medline]
PHST- 2019/01/11 06:00 [entrez]
AID - 10.1055/s-0038-1677018 [doi]
PST - ppublish
SO  - Semin Thromb Hemost. 2019 Feb;45(1):22-35. doi: 10.1055/s-0038-1677018. Epub 2019 
      Jan 10.