title: An abnormal activated partial thromboplastin time clotting waveform is associated with high mortality and a procoagulant state.
abstract: We studied the associations of a biphasic waveform identified in 61 consecutive patients by activated partial thromboplastin times performed with an MDA 180 coagulation analyzer (bioMérieux Inc., Durham, NC, USA). The patients were encountered in a wide range of locations, including medical and surgical services, emergency and outpatient departments, and intensive care unit. The patients encountered also had a variety of clinical diagnoses. Of the patients, 42.6% were dead on follow-up evaluation at 3 months, and 67.2% had a clinical condition known to predispose to the development of disseminated intravascular coagulation (DIC). Sepsis was the most frequent associated condition and was present in 54% of the patients. Only 6 patients had overt DIC according to a standardized scoring system. However, D-dimer was elevated in 90% of patients, and antithrombin III and protein C levels decreased in 75.4% and 63.9%, respectively. The platelet count was decreased in 26%. Our results indicated that a biphasic waveform is associated with high mortality in general hospital patients and is frequently associated with sepsis. This waveform appears to be associated with a consumptive procoagulant state, which may represent early or nonovert DIC.
authors.affiliation: Department of Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada. b.fernandes@utoronto.ca
authors.forename: Bernard
authors.initials: B
authors.lastname: Fernandes
authors.forename: Alan
authors.initials: A
authors.lastname: Giles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000175:diagnosis; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D015996:Survival Rate; D019851:Thrombophilia / Q000097:blood / Q000175:diagnosis*