Aspirin Inhibition Test–Accumetrics

On December 30, Pat Doleski at Kaleida Health asked, We perform aspirin and P2Y12 (clopidogrel) testing using the Accumetrics at two different sites in our hospital system. Twice per year we perform an “inter-lab” on a patient sample to show comparability. We use the 10% CV listed in the insert to determine acceptability, which works […]

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Antiplatelet Therapy

Jan 10 2015

george

Xarelto Bleeding Risks

Since November of 2014, several lawyer-inspired Facebook threads have implicated rivaroxaban (Xarelto) in instance of “uncontrollable bleeding events and blood clots.” The October 9, 2014 issue of the ASH‘s Blood journal presents a meta-analysis that reviewed twelve randomized controlled trials involving 102,607 patients taking TSOACs (target-specific oral anticoagulants, direct oral anticoagulants (DOACs). The authors conclude […]

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Anticoagulant Therapy

Jan 10 2015

george

Anti-Xa AC Reversal: Phase III Results

On January 9, 2014, Portola Pharmaceuticals announced the results of their phase III trial of intravenous Andexanet Alfa, an anti-Xa reversal agent. The trial, ANNEXA-R, tested Andexanet against rivaroxaban, however subsequent trials will generalize it to the additional anti-Xa‘s apixaban and edoxaban. Dave McGlasson comments and a January 9 article appears in The Heart, which […]

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Anticoagulant Therapy

Jan 10 2015

george

FDA Clears Edoxaban

On Thursday, January 8, 2014, the FDA cleared edoxaban (Savaysa, Daiichi-Sankyo) for reducing risk of ischemic stroke in non-valvular atrial fibrillation (AFIB) and for treating DVT and PE in patients who have already been receiving an anticoagulant by injection or by infusion for 5 to 10 days. The anticoagulant joins apixaban and rivaroxaban as the […]

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Anticoagulant Therapy

Dec 22 2014

george

Welcome to the Updated Fritsma Factor

Hello, and welcome to our newly refreshed Fritsma Factor. The site is now mobile-friendly so you don’t have to be tied to a computer. Visit the site from your smart phone or tablet and it will automatically adjust to fit your screen. Besides our refreshed look and feel, we have improved the navigation and provided easy access to posts […]

Events

Unexplained Prolonged PTT

From Dr. Samir Patel: George, I have enjoyed reading the blog for many years now (since fellowship) and am wondering if you could shed some light on a patient I am working up. This is a 90 year old woman who was sent for evaluation after she developed a hematoma post cardiac catheterization (no need […]

Coagulation Factors

Yet More on Promacta

This is from friend and colleague, Dean Willett, Instrumentation Laboratory: Hi, George; A few points to consider… There are two potential sources of interference here: biochemical and optical. Much like hemolysis, if the sample contains biochemical interference, results will be affected regardless of detection method. In the absence of any data it’s not clear if this drug […]

Bleeding Disorders

More on Promacta

From my friend Ali Sadeghi-Khomami, PhD, Precision Biologic Inc: Eltrombopag is a diazo derived compound that acts like pH indicators, i. e., it changes colour at different concentrations of hydronium ions. Thus it is expected that it interferes with chromogenic assays such as the bilirubin assay, especially when assay calibration will not match the colour of the testing sample. […]

Bleeding Disorders

Promacta and Brown Plasma

From John Mitsios, MD at Cornell. Hi George! I had a question regarding the effects of eltrombopag (Promacta®, a TPO stimulating agent), which is typically given to patients with immune thrombocytopenic purpura (ITP), on routine coagulation assays. The reason for this question is that it has been observed in some patients that at high doses the plasma […]

Bleeding Disorders

QQ Responses: Platelet Function

Here are the results of our November, 2014 Quick Question: What platelet function test do you use for platelet function disorders and/or for aspirin and clopidogrel efficacy? a. Siemens PFA-100: 35%, 24 votes b, Accumetrics VerifyNow: 25%, 17 votes c. Light transmittance aggregometry: 18%, 12 votes d. None: 10%, 7 votes e. Whole blood impedance […]

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Antiplatelet Therapy

All Posts

Aspirin Inhibition Test–Accumetrics

Xarelto Bleeding Risks

Anti-Xa AC Reversal: Phase III Results

FDA Clears Edoxaban

Welcome to the Updated Fritsma Factor

Unexplained Prolonged PTT

Yet More on Promacta

More on Promacta

Promacta and Brown Plasma

QQ Responses: Platelet Function

George Fritsma MS MLS

Cheat Sheets from George

Questions or Comments?

Quick Question