A high prothrombin time is dangerous

When the prothrombin time (PT) exceeds the normal value for more than 3 seconds, one should be alert to the risk of bleeding. The risk significantly increases when the international normalized ratio (INR) is greater than 4.5. Abnormal coagulation function is mainly related to factors such as vitamin K deficiency, liver disease, use of anticoagulant drugs, genetic coagulation factor deficiency, disseminated intravascular coagulation, etc.

1. Vitamin K deficiency:

Vitamin K is an essential coenzyme for synthesizing coagulation factors II, VII, IX, and X. Long term dietary imbalance, biliary obstruction, or broad-spectrum antibiotic use may lead to deficiency. Symptoms include gum bleeding and subcutaneous bruising, which can be improved by oral intake of vitamin K1 or adjusting dietary structure. Foods such as animal liver, spinach, and broccoli are rich in vitamin K.

2. Liver diseases:

Liver diseases such as cirrhosis and hepatitis can lead to impaired synthesis of coagulation factors, and PT prolongation is often accompanied by elevated transaminase levels and hypoalbuminemia. Patients may experience symptoms such as gastrointestinal bleeding and nosebleeds, which need to be corrected through liver protection treatment and infusion of fresh frozen plasma. Regular monitoring of liver function and coagulation indicators is also required.

3. Effects of anticoagulant drugs:

Vitamin K antagonists such as warfarin can inhibit coagulation factor activation, resulting in a narrow treatment window. The INR value is within the treatment range of 2.0-3.0. When it exceeds 4.5, the risk of spontaneous bleeding increases threefold. It is necessary to adjust the dosage in a timely manner and monitor for signs of intracranial hemorrhage.

4. Hereditary coagulation defects:

Hemophilia B factor IX deficiency or rare genetic diseases such as factor V and VII deficiency, manifested as recurrent joint bleeding from a young age and abnormal postoperative bleeding. Diagnosis needs to be confirmed through genetic testing, and specific clotting factor concentrate should be administered during acute bleeding.

5. Diffuse intravascular coagulation: DIC caused by severe infections, malignant tumors, or obstetric emergencies can lead to excessive depletion of coagulation factors, significant prolongation of PT accompanied by a decrease in fibrinogen and an increase in D-dimer. Urgent treatment of the primary disease is required, along with supplementation of coagulation factors and platelets. Patients with coagulation dysfunction should avoid vigorous exercise and trauma, and use a soft bristled toothbrush to reduce the risk of gum bleeding. A balanced intake of vitamin K is necessary for diet, but those taking warfarin need to maintain a stable daily intake of vitamin K. Regularly monitor PT/INR values and assess coagulation status in advance before surgery. When experiencing bleeding symptoms such as headache, vomiting blood, and black stool, immediate medical attention is necessary, especially for elderly patients and those with concomitant hypertension who need to be vigilant about the risk of intracranial hemorrhage.