Can mangosteen prolong activated partial thromboplastin time (aPTT)?

Mangosteen's Effect on Activated Partial Thromboplastin Time (aPTT)

Mangosteen does not have established evidence showing it prolongs activated partial thromboplastin time (aPTT). None of the provided guidelines or research evidence mentions mangosteen as having anticoagulant properties that affect aPTT.

Understanding aPTT and Factors That Affect It

aPTT is a laboratory test that measures the intrinsic and common pathways of coagulation. According to the evidence, several factors can prolong aPTT:

Established Causes of Prolonged aPTT

• Medications:

  • Unfractionated Heparin (UFH): Most common medication cause of prolonged aPTT, with therapeutic range of 1.5-2.5 times control 1
  • Direct thrombin inhibitors like dabigatran 1
  • Factor Xa inhibitors may affect aPTT to varying degrees 1

• Coagulation Factor Deficiencies:

  • Deficiencies in factors VIII, IX, and XI can prolong aPTT 2
  • Factor XII deficiency can cause isolated aPTT prolongation without bleeding risk 1

• Inhibitors:

  • Lupus anticoagulant is the most common inhibitor causing prolonged aPTT 1

• Pre-analytical Variables:

  • Underfilled specimen tubes can falsely prolong aPTT values 3
  • Poor collection techniques 4

Clinical Implications

The American College of Cardiology notes that "the cause of an abnormal aPTT is more important than the degree of abnormality itself when assessing clinical risk" 1. This is supported by research showing that among patients with prolonged aPTT:

• 50% had a true hemostatic defect
• 36% had no particular risk
• 14% had artifactually prolonged results 4

Monitoring Considerations

When monitoring anticoagulation:

• For patients on heparin therapy with baseline aPTT prolongation, anti-Xa monitoring is preferred 1
• The relationship between aPTT and anticoagulant concentration is often nonlinear 5
• Concomitant medications like warfarin can affect aPTT; for each increase of 1.0 in INR, the aPTT increased 16 seconds in one study 6

Conclusion on Mangosteen

While various medications, coagulation factor deficiencies, and inhibitors are well-documented causes of prolonged aPTT, there is no evidence in the provided guidelines or research that mangosteen has any effect on aPTT. If a patient taking mangosteen supplements shows prolonged aPTT, other established causes should be investigated first.