2. 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.
3. 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.
4. 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.
5. 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.
This article was last reviewed on May 2, 2014. | This article was last modified on May 2, 2014.
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