Activated Partial Thromboplastin Time (APTT)

The partial thromboplastin time (PTT; also known as activated partial thromboplastin time (aPTT)) is a screening test that helps evaluate a person’s ability to appropriately form blood clots. It measures the number of seconds it takes for a clot to form in a sample of blood after substances (reagents) are added. The PTT assesses the amount and the function of certain proteins in the blood called coagulation or clotting factors that are an important part of blood clot formation. 

When body tissue(s) or blood vessel walls are injured, bleeding occurs and a process called hemostasis begins. Small cell fragments called platelets stick to and then clump (aggregate) at the injury site. At the same time, a process called the coagulation cascade begins and coagulation factors are activated in a step-by-step process. Through the cascading reactions, threads called fibrin form and crosslink into a net that clings to the injury site and stabilizes it. This forms a stable blood clot to seal off injuries to blood vessels, prevents additional blood loss, and gives the damaged areas time to heal. 

Each part of this hemostatic process must function properly and be present in sufficient quantity for normal blood clot formation. If the amount of one or more factors is too low, or if the factors cannot do their job properly, then a stable clot may not form, and bleeding continues. 

With a PTT, the result is compared to a normal reference interval for clotting time. When the PTT takes longer than normal to clot, the PTT is considered “prolonged.” 

When a PTT is used to investigate bleeding or clotting episodes or to rule out a bleeding or clotting disease (e.g., preoperative evaluation), it is often ordered along with a prothrombin time (PT). A health care practitioner will evaluate the results of both tests to help rule out or determine the cause of bleeding or clotting disorder. 

It is now understood that coagulation tests such as the PT and PTT are based on what happens artificially in the test setting (in vitro) and thus do not necessarily reflect what actually happens in the body (in vivo). Nevertheless, they can be used to evaluate certain components of the hemostasis system. The PTT and PT tests each evaluate coagulation factors that are part of different groups of chemical reaction pathways in the cascade, called the intrinsic, extrinsic, and common pathways. 

The PTT is used to evaluate the coagulation factors XII, XI, IX, VIII, X, V, II (prothrombin), and I (fibrinogen) as well as prekallikrein (PK) and high molecular weight kininogen (HK). 

A PT test evaluates the coagulation factors VII, X, V, II, and I (fibrinogen).