As part of an investigation of excessive bleeding or inappropriate blood clot formation (thrombotic episode), particularly to evaluate the level and function of fibrinogen; to detect heparin contamination
Thrombin Time
Thrombin Time
Also Known As
TT
Thrombin Clotting Time
Formal Name
Thrombin Time
This article was last reviewed
on
This article waslast modified
on November 5, 2017.
At a Glance
Why Get Tested?
Sample Required?
A blood sample drawn from a vein in your arm
Test Preparation Needed?
None
Accordion Title
Common Questions
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How is it used?
The thrombin time (TT) may sometimes be used as part of an investigation of a possible bleeding disorder or inappropriate blood clot formation (thrombotic episode), particularly to evaluate the level and function of fibrinogen.
The clotting-based functional fibrinogen assay is now routinely available in clinical laboratories and has largely replaced the need for thrombin time for evaluation of fibrinogen.
This test is very sensitive to the anticoagulant heparin. Because of this, it was once used to monitor unfractionated heparin therapy and to detect heparin contamination in a blood sample. While it is still sometimes used for these purposes, other tests and heparin neutralization procedures have largely replaced it.
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When is it ordered?
A thrombin time may be ordered by itself or along with a combination of other tests when a person has bleeding or clotting episodes, experiences recurrent miscarriages, or has unexplained prolonged results on primary coagulation tests such as prothrombin time (PT) or partial thromboplastin time (PTT).
This test may be ordered when a health practitioner suspects that a person may have a disorder associated with decreased or dysfunctional fibrinogen. However, as mentioned previously, the functional fibrinogen assay (with or without a fibrinogen antigen assay) has largely replaced thrombin time for evaluating fibrinogen.
A thrombin time may sometimes be ordered when heparin contamination of a sample is suspected or when a person is receiving heparin therapy, although these uses have declined.
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What does the test result mean?
Significantly prolonged thrombin times are most commonly found when there is contamination of the blood sample by the anticoagulant heparin, direct thrombin inhibitor, and may be seen with heparin-like substances and inhibitors (e.g., fibrinogen/fibrin degradation products). Contamination can occur when a person is on heparin therapy and/or when heparin is used as a periodic flushing agent to keep intravenous catheters from clotting.
A prolonged thrombin time may indicate decreased fibrinogen level (hypofibrinogenemia or afibrinogenemia) and/or abnormal fibrinogen function (dysfibrinogenemia). Conditions such as disseminated intravascular coagulation (DIC) or abnormal fibrinolysis impair fibrin formation and can also lead to a prolonged thrombin time, as can conditions such as end stage liver disease or malnutrition.
If thrombin time is abnormal, additional tests may be needed, including fibrinogen activity assay (now routinely available in clinical laboratories), fibrinogen antigen assay, and liver function tests.
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Is there anything else I should know?
The thrombin time is just one component of the battery of tests typically required to evaluate a bleeding or thrombotic disorder.
A significant percentage of people with decreased or dysfunctional fibrinogen will have no symptoms or mild symptoms and may only be diagnosed if the abnormality is discovered during testing for another reason, or because they have unexpected or prolonged bleeding following a surgical procedure or trauma.
Fibrinogen is one of several blood factors that are called acute phase reactants. Blood levels of fibrinogen along with other acute phase reactants rise sharply with conditions causing acute tissue inflammation or damage.
Genetic molecular testing is occasionally performed on those with inherited dysfibrinogenemia, hypofibrinogenemia, or afibrinogenemia to identify the genetic mutation responsible. Testing for this mutation may also be performed on other family members.
Some recurrent miscarriages are thought to be related to inappropriate clotting in placental blood vessels.
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Can the thrombin time be performed in my doctor's office?
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Can I have decreased or abnormal fibrinogen and not know it?
Yes. For many people, the clotting process functions relatively normally even when fibrinogen concentrations and/or activity are decreased. Your condition may not be identified unless pre-surgery screening identifies a potential problem or you bleed longer than expected after a surgical procedure or trauma.
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Are there treatments available for decreased or dysfunctional fibrinogen?
Treatment is not needed in most cases, but people with significant bleeding may be given fibrinogen replacements like cryoprecipitate or fresh frozen plasma on a short-term basis to replace fibrinogen. Those who have recurrent inappropriate clotting may require anticoagulation therapy with anticoagulants such as warfarin (COUMADIN®) or subcutaneous heparin. See the article on Blood Banking: Blood and Components for more about these treatments.
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What is a reptilase time (RT) and how is it used?
If heparin is suspected as the cause of a prolonged thrombin time (TT), heparin assays or reptilase time (RT) can be used to confirm heparin presence. RT measures the time it takes for a clot to form after reptilase has been added to plasma. TT may be ordered with an RT to investigate a prolonged clotting time. Since TT, but not RT, is affected by the anticoagulant heparin, prolongation of both TT and RT indicates decreased fibrinogen level and/or abnormal function of fibrinogen. If TT is prolonged but RT is normal, heparin contamination is likely the cause. The clotting-based functional fibrinogen assay is now routinely available in clinical laboratories and has largely replaced the need for TT and RT for evaluation of fibrinogen.
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Can thrombin time be used for monitoring dabigatran therapy?
Dabigatran, a direct thrombin inhibitor, is one of the newly approved oral anticoagulants. Routine therapeutic monitoring is not required; however, monitoring may be needed in certain clinical conditions. Thrombin time (TT) or a modified plasma-diluted thrombin time (dTT) has been advocated for monitoring dabigatran therapy, but it has not been widely accepted as the standard practice. Instead, direct measurement of dabigatran level should be used if monitoring is indicated.