Activated partial thromboplastin time (APTT) - plasma

Last updated: Friday, 04, June, 2010

MBS Online Search Page: Click here for details

Item Process
Specimen

4.5 mL blood added to 0.5 mL citrate.

The sample must not be collected in to heparinised syringes or tubes, or from heparinised lines. 
See Table 1.

Method

Recalcification of platelet-poor plasma at 37°C in the presence of an activator and platelet substitute.

Measure time to clot.

Reference Interval

Commonly around 25-35 seconds, but varies with reagents and method - consult pathologist or laboratory.

The therapeutic interval for continuous infusion heparin varies with the reagents used and should be checked with the laboratory.

Application

Used as an initial test with the PT/INR when a coagulopathy is suspected.

A baseline APTT prior to heparin therapy may detect a lupus inhibitor or other coagulopathies.

The APTT is used to monitor full dose continuous infusion IV heparin therapy but is usually not required to monitor 'prophylactic' subcutaneous heparin.

If monitoring is required for low molecular weight heparin therapy an Anti Xa (Anti factor Xa; Heparin assay) - plasma assay is required.

In isolation, it is inappropriate as a routine preoperative screening test, due to its limited sensitivity and specificity.

Interpretation

A normal APTT does not exclude mild, but clinically significant, coagulation factor deficiency (eg, as in mild haemophilia, von Willebrand's disease) as many reagents give a prolonged APTT only at coagulation factor levels of 30%.

An isolated prolongation of the APTT (PT normal) suggests deficiency of factor VIII, IX, XI or XII.

Prolongation of both the APTT and PT suggests factor X, V, II or I (fibrinogen) deficiency, all of which are rare. The APTT is normal in factor VII deficiency (PT prolonged) and factor XIII deficiency. See Figure 1.

A prolonged APTT which is not corrected by the in vitro addition of normal plasma suggests a coagulation factor (eg, VIII or IX) inhibitor or a lupus inhibitor.

Artefactual prolongation of the APTT may be due to:
the presence of heparin in the sample;
difficult or slow collection;
addition of an incorrect volume of blood to the tube;
delay in mixing blood with the citrate anticoagulant; or
suboptimal specimen storage or a prolonged interval between collection and testing.

See also Bleeding and Anticoagulant monitoring.

Reference