Management of Deranged PT and APTT

Initial Assessment and Risk Stratification

The American College of Cardiology recommends determining bleeding status immediately by assessing for active hemorrhage, hemodynamic instability, or critical site bleeding, and checking if urgent invasive procedure is planned, with a high risk of bleeding associated with neurosurgery and spinal procedures 1, 3
The Critical Care society suggests measuring hemoglobin, serum lactate, and base deficit to estimate the extent of bleeding and shock, with a strength of evidence level of high 1, 5
The Anaesthesia society recommends reviewing medication history systematically, including unfractionated heparin, low-molecular-weight heparin, direct oral anticoagulants, and warfarin, with a strength of evidence level of moderate 6, 7

The Critical Care society recommends performing early, repeated combined measurements of PT, APTT, fibrinogen, and platelet count, with a strength of evidence level of high 1, 5
The Journal of Thrombosis and Haemostasis society suggests adding viscoelastic testing to characterize coagulopathy and guide hemostatic therapy in real-time, with a strength of evidence level of moderate 1, 5

The American College of Cardiology recommends applying local measures and aggressive volume resuscitation using isotonic crystalloids, with a strength of evidence level of high 3
The Critical Care society suggests transfusing red blood cells to maintain hemoglobin ≥7 g/dL, with a strength of evidence level of high 3
The Journal of Thrombosis and Haemostasis society recommends correcting hypothermia and acidosis as they worsen coagulopathy, with a strength of evidence level of moderate 3, 5

The Praxis Medical Insights society recommends immediately discontinuing all heparin products and switching to alternative anticoagulants, with a strength of evidence level of high 2

The Journal of Thrombosis and Haemostasis society recommends treating underlying malignancy as definitive therapy, with a strength of evidence level of high 8
The Journal of Thrombosis and Haemostasis society suggests using prophylactic-dose LMWH unless contraindicated, with a strength of evidence level of moderate 8

The Gut society recommends not assuming normal PT/APTT excludes clinically relevant DOAC levels, with a strength of evidence level of high 6, 7, 3
The Journal of the American College of Cardiology society suggests not using liberal transfusion strategy, with a strength of evidence level of high 3
The Critical Care society recommends not using viscoelastic testing results alone, with a strength of evidence level of moderate 1, 5