Partial Thromboplastin Time

Partial thromboplastin time (PTT) is a blood test that measures the time it
takes blood to clot. A PTT test can be used to screen for bleeding
abnormalities.
At least a dozen blood proteins, or blood factors, are needed to clot blood
and stop bleeding (coagulation). The partial thromboplastin time is an
important coagulation test because the time it takes your blood to clot may
be affected by:

Medications you take to prevent the formation of blood clots (bloodthinning medication), such as heparin. The activated partial
thromboplastin time (APTT) test is used after taking blood-thinners to
determine the most effective dosage of medication that prevents blood
clots.

Low levels of blood proteins (blood clotting factors).

A decrease in activity of any of the factors.

The absence of any of the factors.

The presence of a substance that blocks the activity of any of the

factors.

Another blood clotting test, called prothrombin time (PT), measures the
function of several other clotting factors. Prothrombin time is often

measured along with partial thromboplastin time to evaluate bleeding

abnormalities. These two tests together screen for problems with the
normal blood clotting process and can detect most blood clotting problems
caused by abnormal amounts of or abnormal function of coagulation
factors.

Why It Is Done
Partial thromboplastin time (PTT) is done to:

Determine a possible cause of abnormal bleeding or bruising.

Screen for deficiencies of certain blood clotting factors. The lack of

some clotting factors can cause bleeding disorders such as hemophilia.

Screen for conditions that cause abnormal clotting or blood clot

formation. Conditions such as antiphospholipid antibody syndrome or
lupus anticoagulant syndrome develop when the immune system
produces antibodies that attack certain blood clotting factors, causing
the blood to clot easily in veins and arteries.

Screen blood clotting time before a surgery.

The activated partial thromboplastin time (APTT) test is used to determine

the most effective dosage of some medications, such as heparin, that
prevent blood clots. If the test is done for this purpose, an APTT may
initially be repeated every few hours. When the correct dosage is found,
the frequency of testing is decreased.

How To Prepare

Many medications can affect PTT test results. Tell your health professional
about all medications you are taking, both prescription and
nonprescription, before having this test. No other special preparations are
required before having this test.

How It Is Done
The health professional drawing blood will:

Wrap an elastic band around your upper arm to stop the flow of
blood. This makes the veins below the band larger so it is easier to put
a needle into the vein.

Clean the needle site with alcohol.

Put the needle into the vein. More than one needle stick may be
needed.

Attach a tube to the needle to fill it with blood.

Remove the band from your arm when enough blood is collected.

Apply a gauze pad or cotton ball over the needle site as the needle
is removed.

Apply pressure to the site and then a bandage.

How It Feels
You may feel nothing at all from the needle puncture, or you may feel a
brief sting or pinch as the needle goes through the skin. Some people feel
a stinging pain while the needle is in the vein. However, many people do
not feel any pain (or have only minor discomfort) once the needle is

positioned in the vein. The amount of pain you feel depends on the skill of
the health professional drawing the blood, the condition of your veins, and
your sensitivity to pain.

Risks
Blood test
There is very little risk of complications from having blood drawn from a
vein.

You may develop a small bruise at the puncture site. You can reduce
the risk of bruising by keeping pressure on the site for several minutes
after the needle is withdrawn.

Rarely, the vein may become inflamed after the blood sample is
taken. This condition is called phlebitis and is usually treated with a
warm compress applied several times daily.

Continued bleeding can be a problem for people with bleeding

disorders. Aspirin, warfarin (Coumadin), and other blood-thinning
medications can also make bleeding more likely. If you have bleeding or
clotting problems, or if you take blood-thinning medication, tell your
health professional before your blood is drawn.

Results
Partial thromboplastin time (PTT) is a blood test that measures the time it
takes blood to clot.

Normal

Normal values may vary from lab to lab.

Partial thromboplastin time (PTT):

3045 seconds

Activated partial thromboplastin time

2539 seconds

(APTT):
The heparin dosage for people being treated to prevent the formation of
blood clots is usually adjusted so that the PTT or APTT is about 1.5 to 2.5
times the normal value.

Abnormal values

A longer-than-normal PTT or APTT can indicate a deficiency or

abnormality of one of the blood clotting factors or another substance
needed to clot blood. A deficiency of one or more of these factors
results in a bleeding disorder (such as hemophilia or von Willebrand's
disease).

A long PTT or APTT can be caused by liver disease, kidney disease

(such as nephrotic syndrome), or treatment with medications such as
heparin or warfarin (Coumadin) that are used to prevent the formation
of blood clots.

A long PTT may be caused by conditions such as antiphospholipid

antibody syndrome and lupus anticoagulant syndrome that can cause
abnormal clotting or blood clot formation. These syndromes are a
complication of lupus in which the immune system produces antibodies
that attack certain blood clotting factors, causing the blood to clot easily
in veins and arteries.

PTT can be increased when aspirin is used during heparin therapy,

so the PTT value needs to be closely monitored.

What Affects the Test

Factors that can interfere with your test and the accuracy of the results
include:

Some herbal products or natural remedies.

Some medications, such as antihistamines.

What To Think About

The partial thromboplastin time (PTT) and activated partial

thromboplastin time (APTT) may be normal in people who have
inherited bleeding disorders with only mild symptoms.

The APTT is used to monitor treatment of people who are receiving

heparin or other blood-thinning medication to prevent the formation of
blood clots.

Sometimes people who are receiving heparin have an increased

APTT because of other substances in their blood and not because of
blood-thinning treatment. A test called the heparin neutralization assay
may be done to determine whether this is the case.

Another blood clotting test, called prothrombin time (PT), measures

the function of several other clotting factors. Prothrombin time is often
measured along with partial thromboplastin time to evaluate bleeding
abnormalities. For more information, see the medical test Prothrombin
Time (PT).

A-PTT
Partial Thromboplastin Time
Activated Partial Thromboplastin Time, APTT (Activated Parital Thromboplastin
Time), PTT (Partial Thromboplastin Time)

Test Overview
Partial thromboplastin time (PTT) is a blood test that measures the time it
takes your blood to clot. A PTT test can be used to check for bleeding
problems.
About 12 blood clotting factors are needed for blood to clot (coagulation). The
partial thromboplastin time is an important test because the time it takes your
blood to clot may be affected by:

Blood-thinning medicine, such as heparin. Another test, the activated

partial thromboplastin time (APTT) test, is a better test to find out if
the right dose of heparin is being used.
Low levels of blood clotting factors.
A change in the activity of any of the clotting factors.
The absence of any of the clotting factors.
Other substances, called inhibitors, that affect the clotting factors.
An increase in the use of the clotting factors.

Another blood clotting test, called prothrombin time (PT), measures other
clotting factors. Partial thromboplastin time and prothrombin time are often
done at the same time to check for bleeding problems caused by a problem
with the clotting factors.

Why It Is Done
Partial thromboplastin time (PTT) is done to:

Find a cause of abnormal bleeding or bruising.

Check for low levels of blood clotting factors. The lack of some clotting
factors can cause bleeding disorders such as hemophilia.

Check for conditions that cause clotting problems. Conditions such as

antiphospholipid antibody syndrome or lupus anticoagulant syndrome
develop when the immune system makes antibodies that attack blood
clotting factors. This can cause the blood to clot easily in veins and
arteries.
Check blood clotting time before a surgery.
Check to see whether the dose of anti-clotting medicine is right.

The activated partial thromboplastin time (APTT) test is used after you take
blood-thinners to see if the right dose of medicine is being used. If the test is
done for this purpose, an APTT may be done every few hours. When the correct
dose of medicine is found, you will not need so many tests.

How To Prepare
Many medicines can change the results of this test. Be sure to tell your doctor
about all the nonprescription and prescription medicines you take.

How It Is Done
The health professional drawing blood will:

Wrap an elastic band around your upper arm to stop the flow of blood.
This makes the veins below the band larger so it is easier to put a needle
into the vein.
Clean the needle site with alcohol.
Put the needle into the vein. More than one needle stick may be needed.
Attach a tube to the needle to fill it with blood.
Remove the band from your arm when enough blood is collected.
Put a gauze pad or cotton ball over the needle site as the needle is
removed.
Put pressure to the site and then a bandage.

How It Feels
The blood sample is taken from a vein in your arm. An elastic band is wrapped
around your upper arm. It may feel tight. You may feel nothing at all from the
needle, or you may feel a quick sting or pinch.

Risks
There is very little chance of a problem from having blood sample taken from a
vein.

You may get a small bruise at the site. You can lower the chance of
bruising by keeping pressure on the site for several minutes.
In rare cases, the vein may become swollen after the blood sample is
taken. This problem is called phlebitis. A warm compress can be used
several times a day to treat this.
Ongoing bleeding can be a problem for people with bleeding disorders.
Aspirin, warfarin (Coumadin), and other blood-thinning medicines can
make bleeding more likely. If you have bleeding or clotting problems, or
if you take blood-thinning medicine, tell your doctor before your blood
sample is taken.

Results
Partial thromboplastin time (PTT) is a blood test that measures the time it
takes your blood to clot. Normal values may vary from lab to lab.

Normal
Partial thromboplastin time
Partial thromboplastin time (PTT):
Activated partial thromboplastin time (APTT):

6070 seconds
3040 seconds

The heparin dose is changed so that the PTT or APTT result is about 1.5 to 2.5
times the normal value.

Abnormal values

A longer-than-normal PTT or APTT can mean a lack of or low level of one

of the blood clotting factors or another substance needed to clot blood.
This can cause bleeding disorders, such as hemophilia or von Willebrand's
disease.
A longer-than-normal PTT or APTT can be caused by liver disease, kidney
disease (such as nephrotic syndrome), or treatment with blood thinners,
such as heparin or warfarin (Coumadin).
A longer-than-normal PTT may be caused by conditions such as
antiphospholipid antibody syndrome and lupus anticoagulant syndrome
that cause clotting problems. These syndromes are a complication of
lupus in which the immune system makes antibodies that attack blood
clotting factors. This can cause the blood to clot easily in veins and
arteries.

The PTT can get longer when you are using heparin, so your PTT value
needs to be closely checked.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be
helpful include:

Taking some herbal products or natural remedies.

Taking some medicines, such as antihistamines or aspirin.

What To Think About

The partial thromboplastin time (PTT) and activated partial

thromboplastin time (APTT) may be normal in people who have inherited
bleeding disorders but have only mild symptoms.
The APTT is used to check treatment of people who are using heparin or
other blood-thinning medicine to prevent blood clots.
Sometimes people who use heparin have a higher APTT because of other
substances in their blood and not because of blood-thinning medicines. A
test called the heparin neutralization assay may be done to see if this is
true.
Another blood clotting test, called prothrombin time (PT), measures
other clotting factors. Partial thromboplastin time and prothrombin time
are often done at the same time to check for bleeding problems. For
more information, see the medical test Prothrombin Time (PT).
An PTT or APTT is done regularly in people who have bleeding or clotting
problems. The tests are also done before procedures or surgeries where
too much bleeding may be a concern.

References
Other Works Consulted

Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic
Procedures, 4th ed. Philadelphia: Saunders.
Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and
Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.
Pagana KD, Pagana TJ (2006). Mosbys Manual of Diagnostic and
Laboratory Tests, 3rd ed. St. Louis: Mosby.

Partial thromboplastin time

Return to Encyclopedia Index P

Definition
The partial thromboplastin time (PTT) test is a blood test that is
done to investigate bleeding disorders and to monitor patients taking
an anticlotting drug (heparin).
Purpose
Diagnosis
Blood clotting (coagulation) depends on the action of substances in
the blood called clotting factors. Measuring the partial
thromboplastin time helps to assess which specific clotting factors
may be missing or defective.
Monitoring
Certain surgical procedures and diseases cause blood clots to form
within blood vessels. Heparin is used to treat these clots. The PTT
test can be used to monitor the effect of heparin on a patient's
coagulation system.
Precautions
Certain medications besides heparin can affect the results of the PPT
test. These include antihistamines, vitamin C (ascorbic acid),
aspirin, and chlorpromazine (Thorazine).
Description
When a body tissue is injured and begins to bleed, it starts a
sequence of clotting factor activities called the coagulation cascade,
which leads to the formation of a blood clot. The cascade has three
pathways: extrinsic, intrinsic, and common. Many of the thirteen
known clotting factors in human blood are shared by both pathways;

several are found in only one. The PTT test evaluates the factors
found in the intrinsic and common pathways. It is usually done in
combination with other tests, such as the prothrombin test, which
evaluate the factors of the extrinsic pathway. The combination of
tests narrows the list of possible missing or defective factors.
Heparin prevents clotting by blocking certain factors in the intrinsic
pathway. The PTT test allows a doctor to check that there is enough
heparin in the blood to prevent clotting, but not so much as to cause
bleeding. The test is done before the first dose of heparin or
whenever the dosage level is changed; and again when the heparin
has reached a constant level in the blood. The PTT test is repeated
at scheduled intervals.
The PTT test uses blood to which a chemical has been added to
prevent clotting before the test begins. About 5 mL of blood are
drawn from a vein in the patient's inner elbow region. Collection of
the sample takes only a few minutes. The blood is spun in a
centrifuge, which separates the pale yellow liquid part of blood
(plasma) from the cells. Calcium and activating substances are
added to the plasma to start the intrinsic pathway of the coagulation
cascade. The partial thromboplastin time is the time it takes for a
clot to form, measured in seconds.
The test can be done without activators, but they are usually added
to shorten the clotting time, making the test more useful for
monitoring heparin levels. When activators are used, the test is
called activated partial thromboplastin time or APTT.
Test results can be obtained in less than one hour. The test is usually
covered by insurance.
Preparation
The doctor should check to see if the patient is taking any of the
medications that may influence the test results. If the patient is on
heparin therapy, the blood sample is drawn one hour before the next
dose of heparin.
Aftercare
Aftercare includes routine care of the puncture site. In addition,
patients on heparin therapy must be watched for signs of
spontaneous bleeding. The patient should not be left alone until the
doctor or nurse is sure that bleeding has stopped. Patients should

also be advised to watch for bleeding gums, bruising easily, and

other signs of clotting problems; to avoid activities that might cause
minor cuts or bruises; and to avoid using aspirin.
Risks
The patient may develop a bruise or swelling around the puncture
site, which can be treated with moist warm compresses. People with
coagulation problems may bleed for a longer period than normal.
Normal results
Normal results vary based on the method and activators used.
Normal APTT results are usually between 25-40 seconds; PTT results
are between 60-70 seconds. APTT results for a patient on heparin
should be 1.5-2.5 times normal values. An APTT longer than 100
seconds indicates spontaneous bleeding.
Abnormal results
Increased levels in a person with a bleeding disorder indicate a
clotting factor may be missing or defective. Further tests are done
to identify the factor involved. Liver disease decreases production of
factors, increasing the PTT.
Low levels in a patient on heparin indicate too little heparin is in the
blood to prevent clots. High levels indicate too much heparin is
present, placing the person at risk of excessive bleeding.
Key Terms
Activated partial thromboplastin time
Partial thromboplastin time test that uses activators to shorten the
clotting time, making it more useful for heparin monitoring.
Clotting factors
Substances in the blood that act in sequence to stop bleeding by
forming a clot.
Coagulation
The process of blood clotting.
Coagulation cascade
The sequence of biochemical activities, involving clotting factors, that
stop bleeding by forming a clot.
Common pathway
The pathway that results from the merging of the extrinsic and
intrinsic pathways. The common pathway includes the final steps

before a clot is formed.

Extrinsic pathway
One of three pathways in the coagulation cascade.
Heparin
A medication that prevents blood clots.
Intrinsic pathway
One of three pathways in the coagulation cascade.
Partial thromboplastin time
A test that checks the clotting factors of the intrinsic pathway.
Plasma
The fluid part of blood, as distinguished from blood cells.
For Your Information
Resources
Periodicals

Berry, Brian R., and Stephen Nantel. "Heparin Therapy: Current

Regimens and Principles of Monitoring." Postgraduate Medicine 99
(June 1996): 64-76.

Partial Thromboplastin Time

Partial thromboplastin time (PTT) is a blood test that measures the time it takes your blood to clot.
A PTT test can be used to check for bleeding problems.
About 12 blood clotting factors are needed for blood to clot (coagulation). The partial
thromboplastin time is an important test because the time it takes your blood to clot may be
affected by:

Blood-thinning medicine, such as heparin. Another test, the activated partial

thromboplastin time (APTT) test, is a better test to find out if the right dose of heparin is being
used.

Low levels of blood clotting factors.

A change in the activity of any of the clotting factors.

The absence of any of the clotting factors.

Other substances, called inhibitors, that affect the clotting factors.

An increase in the use of the clotting factors.

Another blood clotting test, called prothrombin time (PT), measures other clotting factors. Partial
thromboplastin time and prothrombin time are often done at the same time to check for bleeding
problems caused by a problem with the clotting factors.
Why It Is Done
Partial thromboplastin time (PTT) is done to:

Find a cause of abnormal bleeding or bruising.

Check for low levels of blood clotting factors. The lack of some clotting factors can cause
bleeding disorders such as hemophilia.

Check for conditions that cause clotting problems. Conditions such as antiphospholipid
antibody syndrome or lupus anticoagulant syndrome develop when the immune system makes
antibodies that attack blood clotting factors. This can cause the blood to clot easily in veins and
arteries.

Check blood clotting time before a surgery.

Check to see whether the dose of anti-clotting medicine is right.

The activated partial thromboplastin time (APTT) test is used after you take blood-thinners to see
if the right dose of medicine is being used. If the test is done for this purpose, an APTT may be
done every few hours. When the correct dose of medicine is found, you will not need so many
tests.
How To Prepare
Many medicines can change the results of this test. Be sure to tell your doctor about all the
nonprescription and prescription medicines you take.