COMPARISON OF BLOOD COAGULATION PROFILES IN FATAL OVERDOSE VS. THERAPEUTIC DRUG LEVELS: A FORENSIC-HAEMATOLOGICAL STUDY
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Keywords
Coagulation profile, Fatal drug overdose, PT/INR, D-dimer, Disseminated intravascular coagulation, Forensic toxicology
Abstract
Background: This study aimed to compare blood coagulation profiles between confirmed fatal drug overdose cases and individuals with therapeutic drug levels.
Methods: A comparative cross-sectional study was conducted at Saidu Medical College, Swat, from January 2023 to January 2024. Seventy-two participants were included: 36 postmortem cases with toxicologically confirmed fatal overdose and 36 patients with therapeutic drug levels. Blood samples were analyzed for prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, platelet count, D-dimer, and thrombin time. Statistical analysis was performed using SPSS version 26, with p < 0.05 considered significant.
Results: Mean PT (19.4 ± 3.8 sec vs. 14.2 ± 2.6 sec, p < 0.001), INR (1.71 ± 0.34 vs. 1.19 ± 0.20, p < 0.001), and aPTT (42.5 ± 7.4 sec vs. 32.6 ± 5.8 sec, p < 0.001) were significantly prolonged in fatal overdose cases. Fibrinogen levels were lower (178 ± 55 mg/dL vs. 276 ± 64 mg/dL, p < 0.001), and D-dimer levels were markedly elevated (2.85 ± 0.91 µg/mL vs. 1.10 ± 0.60 µg/mL, p < 0.001). Disseminated intravascular coagulation (DIC) was present in 38.8% of overdose cases compared to 8.3% of therapeutic cases (p = 0.004).
Conclusion: Fatal overdose is strongly associated with coagulopathy characterized by prolonged clotting times, hypofibrinogenemia, and elevated D-dimer levels. Routine coagulation screening in suspected overdose cases can aid in forensic interpretation and may have clinical utility in early detection of life-threatening coagulopathy.
Keywords:
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Shafaq Saleem
Lecturer (Haematology), Department of Pathology, Gomal Medical College, Dera Ismail Khan, Pakistan
Umar Alim
Professor, Department of Pharmacology, Saidu Medical College, Swat, Pakistan
Musarat Ali
Ex. Chief Med Officer, DHQ Teaching Hospital, Kohat, Pakistan
Asma Shah
Lecturer, Department of Pathology, Women Medical College, Abbottabad, Pakistan
Fazal Rabbi
Retired as Principal Medical Officer, BS 19 from KP Health Department, Pakistan
Muhammad Sami Khan
Lecturer, Department Pathology, Pak International Medical Collage, Peshawar, Pakistan