Dispelling myths about coagulation abnormalities in internal medicine

Thachil, Jecko

doi:10.7861/clinmedicine.14-3-239

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…The failure to recognize that the hypothetical patient was anticoagulated and that it was not safe to perform an invasive procedure is most likely related to a poor understanding of the limitations of routine coagulation tests applied to a patient taking a DOAC. Poor understanding of the limitations of routine coagulation tests in clinical situations has been well documented previously . Routine coagulation screening tests do not predict perioperative bleeding , and prolonged clotting times occur in some prevalent conditions with no increased bleeding, such as antiphospholipid syndrome and factor XII deficiency.…”

Section: Resultsmentioning

confidence: 99%

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm

Olaiya

Lurie

Watt

et al. 2016

Journal of Thrombosis and Haemostasis

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Ignorance of direct oral anticoagulants' effects on coagulation tests may be a safety issue. An electronic questionnaire was sent to prescribers in NHS Grampian with 143 respondents. We found widespread evidence of inappropriate interpretation of the clinical scenarios given. The study suggests potential for patient harm due to lack of knowledge and education is required.Summary. Background: Lack of awareness of the nature of the direct oral anticoagulants (DOACs) combined with the poor correlation between routine coagulation test prolongation and the activity of these drugs represents a potential for patient harm. Objectives: To establish the level of awareness of the different DOACs, and to assess whether prescribers were able to recognize the state of anticoagulation in a hypothetical patient. Methods and results: An electronic questionnaire was sent by email to prescribers in our health board. Among 143 respondents, we found significant differences in awareness of the currently licensed drugs. Of the respondents, 88%, 80% and 50%, respectively, recognized rivaroxaban, dabigatran, and apixaban. When provided with a routine clinical situation, only 13.5%, 17.5% and 16.8%, respectively, recognized that the hypothetical patient was anticoagulated, and only 55-58% recognized that it was unsafe to proceed with an invasive procedure. Conclusion: These results indicate a significant risk for patient harm related to lack of knowledge about this new group of frequently used drugs, and indicate that additional education and training on this subject are required.

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Section: Resultsmentioning

confidence: 99%

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm

Olaiya

Lurie

Watt

et al. 2016

Journal of Thrombosis and Haemostasis

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“…Most of those previous investigations associated prothrombin time with adenomyosis (34) but not directly with menorrhagia. However, prolonged PT and normal aPTT may re ect vitamin K de ciency caused by malnutrition, biliary obstruction, malabsorption syndromes, antibiotic use, or liver disease, which lowers clotting factor synthesis (35). The prothrombin time test evaluates the extrinsic coagulation pathway (also known as the tissue factor pathway), which comprises factors VII, X, V, and II, while the aPTT evaluates the intrinsic pathway (also known as the ampli cation pathway or contact system), which consists of factors XII, XI, IX, VIII, X, V, and II(36).…”

Section: Discussionmentioning

confidence: 99%

Coagulation hallmark indicators of menorrhagia in a comparative study between menorrhagic and healthy women attending Bungoma County Referral Hospital in Kenya

Marabi,

Musyoki,

Monari

et al. 2024

Preprint

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Background Despite the significant burden of menorrhagia among women in Western Kenya, it remains unknown whether coagulation disorders are one of the important underlying causes of this condition in the region. This study evaluated the differences in coagulation profiles, associations between menorrhagia and coagulation profiles and compared the morphological features of platelets between menorrhagic patients and healthy women attending Bungoma County Referral Hospital in Kenya. Methods A comparative cross-sectional study of women [n = 428 (214 per group), aged 18–45 years] was performed. A Humaclot junior analyzer was used to evaluate prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (PT), fibrinogen, and the international normalized ratio (INR). The platelet count was determined using Celtac F ME822K, and Leishman-stained blood films were analyzed using an Olympus light compound microscope. The Chi-square test was used to analyze categorical descriptive data. The Mann‒Whitney U test was used to compare the data between the menorrhagic and control groups. Binary logistic regression was applied to determine the association between coagulation profile and menorrhagia incidence. The platelet morphological characteristics were reported as frequencies and percentages. Statistical significance was set at p≤0.05 indicated statistical significance. Results The results showed that a history of bleeding disorders (p < 0.0001), PT (p < 0.0001) and INR (p < 0.0001) were greater in menorrhagic women than in non-menorrhagic women. Menorrhagia was significantly associated with a high PT [OR = 2.129, 95% CI = 1.658–2.734; p < 0.0001] and INR [OR = 7.479, 95% CI = 3.094–18.080; p < 0.0001]. No morphological abnormalities in the platelets were observed in either healthy or non-menorrhagic women. Conclusions Family history of bleeding disorders, increased PT and INR are the hallmark indicators of menorrhagia in western Kenya. Therefore, routine assessment of the coagulation profile and history of bleeding disorders is critical for the diagnosis and management of menorrhagia.

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“…Evaluation of patients with bleeding tendency with abnormal prothrombin and activated partial thromboplastin times (PT and aPTT) can be straightforward with common causes include anticoagulant use, disseminated intravascular coagulation (DIC), liver disease, and vitamin K deficiency [ 1 ]. Acquired inhibitors (antibodies) or deficiencies of prothrombin, fibrinogen, factor V, or factor X clotting factors might rarely be the presenting feature of malignancy or autoimmune disease [ 1 ]. Patients with multiple myeloma may have associated clotting factors deficiency especially if associated with AL amyloidosis [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Case Report of Acquired Factor X Deficiency in a Patient With Multiple Myeloma

Sabobeh

Brugioni

Masoud

et al. 2021

Cureus

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Multiple myeloma is a plasma cell neoplasm characterized by clonal proliferation of immunoglobulin producing terminally differentiated B cells. Classically patients are described to present with bone pain, hypercalcemia, anemia, and/or renal impairment. A less described clinical manifestation related to the myeloma is acquired coagulation abnormalities including paraprotein interfering with the coagulation cascade or exhibiting specific antibody activity. Factor X deficiency is reported in patients with secondary amyloidosis. We describe a patient who presented with bleeding tendency and an abnormal prothrombin and activated partial thromboplastin times (PT/PTT) due to factor X deficiency. A thorough workup revealed the diagnosis of multiple myeloma with the presence of monoclonal lambda light chain restricted plasma cells with qualifying end-organ damage without evidence of amyloidosis. Prior to the ultimate diagnosis, the patient succumbed to septic shock and acute respiratory distress syndrome due to Streptococcus Pneumonia infection.

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Dispelling myths about coagulation abnormalities in internal medicine

Cited by 4 publications

References 37 publications

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm

An observational study of direct oral anticoagulant awareness indicating inadequate recognition with potential for patient harm

Coagulation hallmark indicators of menorrhagia in a comparative study between menorrhagic and healthy women attending Bungoma County Referral Hospital in Kenya

A Case Report of Acquired Factor X Deficiency in a Patient With Multiple Myeloma

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