Changes In Coagulation Profile in Pulmonary Tuberculosis Patients Before and after Intensive Phase of Antituberculosis Drugs Therapy

Abstract

Background and Objectives. Pulmonary tuberculosis (TB) induces systemic inflammation that disrupts hemostasis, resulting in elevated fibrinogen, prolonged clotting times, and reactive thrombocytosis. Although anti-tuberculosis therapy (ATT) is expected to normalize these abnormalities, evidence remains limited and inconsistent. This study aimed to evaluate changes in fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts before and after the intensive phase of ATT in bacteriologically confirmed pulmonary TB patients.

Materials and Methods. A prospective cohort study was conducted at Dr. Wahidin Sudirohusodo Hospital and the Makassar Lung Health Center from June to August 2025. Coagulation parameters were measured before treatment initiation and reassessed after two months of intensive-phase therapy. Statistical analyses included paired t-tests and Wilcoxon signed-rank tests based on data distribution. Of 66 enrolled patients, 48 completed follow-up.

Results. Mean fibrinogen significantly decreased from 406.96 to 362.46 mg/dL (p < 0.001). PT improved from 13.48 to 11.96 seconds (p < 0.001), and aPTT decreased from 29.83 to 26.83 seconds (p = 0.005). Platelet counts declined from 421,133/µL to 347,081/µL, although not statistically significant (p = 0.121). Clinical symptoms and radiological findings also demonstrated improvement, including reduced hemoptysis, increased BMI, and decreased pleural effusion.

Conclusions. Intensive-phase ATT markedly improves coagulation disturbances in pulmonary TB, reflected by reductions in fibrinogen and normalization of PT and aPTT. While platelet counts declined, the change was not significant. These findings support the role of ATT in reversing TB-related hypercoagulability and highlight the clinical relevance of monitoring coagulation parameters during treatment.