Are the prothrombin time of 12.8 seconds, INR of 0.9, and activated partial thromboplastin time of 26.8 seconds acceptable for laparoscopic cholecystectomy?

Coagulation Parameters for Laparoscopic Cholecystectomy

These coagulation values (PT 12.8 seconds, INR 0.9, PTT 26.8 seconds) are completely acceptable and within normal limits for laparoscopic cholecystectomy—proceed with surgery without delay. 1

Normal Reference Ranges

Your patient's values fall well within established normal ranges:

• PT 12.8 seconds: Normal range is 11-13.5 seconds 1
• INR 0.9: Normal range is 1.0-1.3, and your value of 0.9 is actually slightly below 1.0, indicating if anything a slightly hypercoagulable state rather than any bleeding tendency 1, 2
• PTT 26.8 seconds: Normal range is 25-35 seconds 1

Clinical Interpretation for Surgery

All three values are within normal limits and pose no contraindication to surgery. 1

The key thresholds that would raise concern for invasive procedures are:

• PT ratio >1.4 (or INR >1.4 for non-warfarin patients) would be considered a relative contraindication 1, 2
• Your patient's PT of 12.8 seconds with a normal control of approximately 11-13 seconds yields a PT ratio of approximately 1.0-1.16, well below the 1.4 threshold 1
• PTT ratio >1.4 would similarly be concerning 1
• Your patient's PTT of 26.8 seconds is in the middle of the normal range (25-35 seconds), yielding a ratio of approximately 0.9-1.1 1

Common Pitfalls to Avoid

Do not delay surgery based on an INR of 0.9. 1 An INR below 1.0 simply reflects normal or slightly enhanced coagulation function and does not predict bleeding risk. 1, 2 The INR was specifically designed and validated only for monitoring vitamin K antagonist (warfarin) therapy, not as a general predictor of bleeding risk in surgical patients. 1

Do not order additional coagulation studies or request "correction" of these normal values. 3 These values indicate normal hemostasis, and further testing would be unnecessary and potentially delay appropriate surgical care. 1

Additional Considerations

While these standard coagulation tests are normal, remember that normal PT/PTT values don't exclude all bleeding disorders, particularly those affecting platelet function. 1 However, in the absence of a personal or family history of abnormal bleeding, these normal screening tests are sufficient for proceeding with laparoscopic cholecystectomy. 3

Platelet count should also be verified (if not already done), as counts <100,000/μL would be a relative contraindication to invasive procedures, but this is separate from the PT/INR/PTT values you've provided. 1