How to deal with significant prolongation of thrombin time

The significant prolongation of thrombin time can be treated by infusing plasma, supplementing vitamin K, investigating drug effects, treating underlying diseases, monitoring anticoagulant drugs, and other methods. Prolonged clotting time is usually caused by factors such as coagulation factor deficiency, use of anticoagulant drugs, liver disease, disseminated intravascular coagulation, genetic coagulation disorders, etc.

1. Transfusion of plasma:

Fresh frozen plasma contains all coagulation factors and can directly supplement the missing clotting substances. Suitable for acute bleeding or preoperative preparation, the infusion dose should be adjusted under the guidance of a doctor based on coagulation function test results. Cross matching of blood types is required before infusion, and vital signs should be closely monitored during the infusion process.

2. Supplementing with Vitamin K:

Vitamin K is an essential substance for synthesizing coagulation factors II, VII, IX, and VII. For coagulation abnormalities caused by vitamin K deficiency, supplementation can be done orally or by intramuscular injection. Patients with malnutrition, long-term use of antibiotics, or biliary obstruction are prone to vitamin K deficiency and require continuous supplementation for 3-5 days to take effect.

3. Investigating drug effects:

Anticoagulants such as warfarin specifically inhibit vitamin K-dependent coagulation factors. If the prolonged clotting time is related to medication, the risk of bleeding should be evaluated before deciding whether to adjust the dosage. Some antibiotics and antiepileptic drugs may also interfere with vitamin K metabolism, and a comprehensive analysis of medication history is needed.

4. Treatment of underlying diseases:

Liver diseases such as cirrhosis can lead to reduced synthesis of coagulation factors, and treatment should be targeted at the primary disease. Diffuse intravascular coagulation requires treatment of triggers such as infection and trauma, and in severe cases, supplementation of coagulation factors and platelets is necessary. Patients with hereditary coagulation factor deficiency may require long-term replacement therapy.

5. Monitoring anticoagulant drugs:

When using heparin or new oral anticoagulants, regular monitoring of thrombin time is necessary. When the detection value exceeds the treatment range by 1.5-2.5 times, it indicates an increased risk of bleeding. For patients with atrial fibrillation, deep vein thrombosis, etc., excessive prolongation of clotting time should be avoided while ensuring anticoagulant effect. Patients with coagulation dysfunction should avoid vigorous exercise and activities that may cause trauma, and increase their intake of green leafy vegetables rich in vitamin K, such as spinach and broccoli, in their diet. Long term users of warfarin should maintain a stable daily intake of vitamin K to avoid sudden and excessive consumption that may affect the efficacy of the medication. Regularly review coagulation function indicators and seek medical attention promptly in case of abnormal conditions such as gum bleeding and subcutaneous bruising. For patients with hereditary coagulation disorders, it is recommended to carry a disease description card with them for emergency needs.