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Are baseline prothrombin time/partial thromboplastin time values necessary before instituting anticoagulation?
1Division of Emergency Medicine, University of Rochester, School of Medicine, New York.
Annals of Emergency Medicine
|April 1, 1993
Summary
Routine baseline prothrombin time (PT) and partial thromboplastin time (PTT) tests are rarely useful before starting anticoagulation therapy. Emergency physicians seldom document bleeding disorder history, and these tests do not alter treatment, suggesting unnecessary testing.
Area of Science:
- Clinical Medicine
- Emergency Medicine
- Hematology
Background:
- Anticoagulation therapy is crucial for managing deep-vein thrombosis and pulmonary embolism.
- Assessing bleeding risk before anticoagulation is a clinical consideration.
Purpose of the Study:
- To evaluate the clinical utility of baseline prothrombin time (PT) and partial thromboplastin time (PTT) before anticoagulation.
- To determine if emergency physicians inquire about bleeding disorder history prior to initiating anticoagulation.
Main Methods:
- Retrospective review of 199 patients diagnosed with deep-vein thrombosis or pulmonary embolism.
- Analysis of documented historical bleeding information, baseline PT/PTT values, and treatment decisions.
Main Results:
- Pertinent bleeding history was documented in 0-8% of patients.
- Baseline PT/PTT were obtained in 94% of patients but rarely altered heparin therapy.
- Elevated PT/PTT values were often due to warfarin, prior heparin, or other factors, not indicative of new bleeding risks.
Conclusions:
- Emergency physicians infrequently document bleeding disorder history.
- Routine baseline PT/PTT testing before anticoagulation is generally not indicated and does not impact immediate treatment.
- Discontinuing routine baseline PT/PTT testing could lead to significant cost savings.