1104. Coagulogram (PT, % by Quick, INR, APTT, Fibrinogen, TT)

A сoagulation panel is a comprehensive laboratory test of the blood coagulation system. It includes key indicators of primary hemostasis: prothrombin time (PT), Quick prothrombin percentage, international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen, and thrombin time (TT). These indicators help identify the underlying causes of thrombosis and bleeding tendencies, and are used for pre- and postoperative screening, cardiovascular risk assessment, and anticoagulant treatment monitoring.

A coagulation profile is a comprehensive laboratory test of the blood coagulation system. Blood clotting is one of the human body's primary defense mechanisms, helping prevent significant blood loss. The blood clotting process (hemostasis) is a complex, self-regulating enzymatic system that stops bleeding and prevents blood clots. However, its function can be influenced by metabolic processes and hormonal levels. A coagulogram can detect hemostasis disorders and prevent complications. These parameters help identify the underlying causes of thrombosis and bleeding tendencies, and are used for pre- and postoperative screening, to assess the risk of developing cardiovascular diseases, and to monitor anticoagulant therapy.

Coagulation profile and Key Indicators

The blood clotting system involves a sequential cascade of reactions involving various coagulation factors and mechanisms of blood clot formation.

This comprehensive test includes key primary hemostasis parameters: prothrombin time (PT), Quick prothrombin percentage, international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen, and thrombin time (TT).

Prothrombin time (PT) and Quick percentage reflect the extrinsic coagulation pathway and the functional state of the prothrombin complex (factors II, V, VII, and X). PT is an important parameter in blood coagulation testing, as it measures the time required for clot formation after the addition of special reagents to a plasma sample. High or low PT levels may indicate serious conditions such as hemophilia, von Willebrand disease, or liver dysfunction.

The international normalized ratio (INR) is a standardized parameter for assessing the effectiveness of treatment with vitamin K antagonists (warfarin). The INR is a key parameter for assessing blood coagulation and the effectiveness of anticoagulant therapy. An elevated INR level may indicate a risk of bleeding, while a decreased INR level may indicate an increased tendency to form blood clots.

APTT (activated partial thromboplastin time) reflects the intrinsic coagulation pathway, sensitive to deficiencies of factors VIII, IX, XI, and XII.

Fibrinogen is the protein that forms fibrin, the base of a blood clot. Its level increases with inflammation, trauma, and pregnancy; it decreases with disseminated intravascular coagulation (DIC) and liver failure.

Thrombin time (TT) assesses the final stage of coagulation: the conversion of fibrinogen to fibrin under the action of thrombin.

Together, these indicators help identify:

• a tendency to thrombosis (hypercoagulability);
• bleeding risks (hypocoagulability);
• coagulation factor deficiencies;
• the effectiveness and safety of anticoagulant therapy.

A modern laboratory performs a coagulation profile to diagnose various disorders of the blood coagulation system. Each indicator is evaluated separately, compared to the results of other indicators.

Normal coagulation parameters

• Prothrombin time (PT, PT)
  Normal parameters: 9.8-12.1 (sec)
• Quick prothrombin
  Normal parameters: 70.0-130.0 (%)
• International normalized ratio
  Normal parameters:
  According to recommendations of international protocols for the treatment and monitoring of anticoagulant therapy:
  • not taking anticoagulants: 0.8-1.2 (MHB/INR);
  • therapeutic limits while taking anticoagulants (indirect action) for the prevention and treatment of:
    • deep thromboembolic vein thrombosis (DEVT): 2.0-3.0 (MHB/INR);
    • after heart surgery in the presence of native valves for the treatment of cardiac fibrillation: 2.0-3.0 (MHB/INR);
    • in case of prosthetic replacement Mitral valve ratio: 2.5-3.5 (MHB/INR);
    • critical thrombotic risk: less than 0.5 (MHB/INR);
    • critical bleeding risk: greater than 5.0 (MHB/INR).
• Activated partial thromboplastin time (APTT)
  Normal values: 22.7-31.8 (sec)
• Thrombin time (TT)
  Normal values: 14.0-21.0 (sec)

The results enables an identifying various disorders in the blood coagulation system and prescribe timely treatment to prevent bleeding and blood clots. A coagulation profile is mandatory before surgery to assess the risk of bleeding or blood clots.

When is a coagulation profile prescribed?

• Before surgery.
• For postoperative monitoring.
• To monitor the progress of chronic diseases (cardiovascular, liver, kidney, autoimmune, oncological).
• Before thrombolytic or anticoagulant therapy (before prescribing medications that affect blood clotting).
• In case of bleeding of unknown origin (hematomas, nasal, uterine, etc.).
• To evaluate the effectiveness of treatment.

Symptoms that indicate a risk of blood clots:

• Sudden pain and swelling in the legs, especially if they occur in one limb, accompanied by redness or warmth in the area.
• Chest pain: sharp, often associated with breathing.
• Shortness of breath and rapid heartbeat: for no apparent reason or with normal physical activity.

Important: These symptoms may be signs of deep vein thrombosis or pulmonary embolism, conditions that require emergency medical attention.

Who is this test recommended for?

• People with cardiovascular disease.
• People with suspected thrombosis or thromboembolism.
• People who are scheduled for or have been prescribed thrombolytic or anticoagulant therapy.
• Patients with chronic liver or kidney disease, autoimmune diseases, or malignant processes.
• People prior to surgery.

• Venous blood

In order to exclude factors that may affect the test results, we recommend to follow the preparation rules: