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Comment & Response
April 11, 2017

Coagulation Testing in a Bleeding Patient

Author Affiliations
  • 1Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
JAMA. 2017;317(14):1478-1479. doi:10.1001/jama.2017.2416

To the Editor The Diagnostic Test Interpretation by Dr Choi and colleagues1 highlighted 3 topics that deserve further discussion: (1) utility of routine coagulation testing; (2) limitations of a mixing study; and (3) appropriateness of a thrombophilia evaluation in a bleeding patient.

Prothrombin time has been validated for monitoring of warfarin. Activated partial thromboplastin time has been validated for monitoring of intravenous heparin and screening for hemophilia in affected families.2 These tests are frequently and often erroneously used and can mislead clinicians into overinvestigating or underinvestigating patients. A prospective study identified 94% of tests for prothrombin time and 99% of tests for activated partial thromboplastin time were ordered unnecessarily.2 For the patient described in the article, it was reasonable to order these tests because the patient was bleeding, but the results could have been falsely normal due to testing limitations.