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Dabigatran Controversy

Here is a Medpage article that broke July 23 describing the concern that Boehringer Ingelheim may have withheld data that supported dabigatran measurement in atrial fibrillation treatment. For the details, see Reilly PA, Lehr T, Haertter S, et al. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation […]

Anticoagulant Therapy

More on HIT Testing: 4 T’s

In follow-up to Julia Witt’s July 9 post requesting information on the PIFA AB rapid test for heparin-induced thrombocytopenia, attached below is an article that defines and illustrates the 4T protocol: Lo GK, Juhl D, Warkentin TE, Igouin S, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical […]

Fibrinolytic to Treat Clotted Fluids

George, This is not really a coag question but relates to an issue we see intermittently in our clinical lab. It is the problem of receiving clotted body fluid specimens with the request of a cell count to be performed. While educating the clinician to put the specimen in an anticoagulant tube is ideal to […]

Discontinue Coumadin?

George is seeking advice on behalf of a colleague. A 78-YO male patient with atrial fibrillation on Coumadin >20 years experiences a large bruise following a fall. The INR is 1.8. The patient also has Parkinson disease >10 years. Would you discontinue Coumadin? Would you propose alternative antithrombotic therapy? Thank you.

Anticoagulant Therapy

Rapid HIT Test

From Julia Witt: Our healthcare system is currently looking at more efficient ways to screen for heparin-induced thrombocytopenia with thrombosis (HIT). Currently we are looking at the Akers Biosciences PIFA AB test. The literature looks good, but I wonder how many are using this test and can it be reliably used as a rule out test for […]

Resource to Compare Analyzers

From Stephanie Morgan: We are comparing analyzers that perform factor assays, platelet studies, thrombosis testing, and other specialty testing while remaining cost efficient. Where would be the best resource to compare analyzers in each category? Thank you. Hello, Stephanie, and thank you for your question. Your best resource is the College of American Pathologists’ CAP Today Product […]

Instrumentation

Reagent and Instrument Variability

From Odetta Hanna, Coagulation Applications Specialist at Sekisui Diagnostics: I was wondering if you could help me locate references or resources to support a statement that I made for Method Comparison: Coagulation: Interpretation of results. I am writing a method comparison procedure and I referenced CLSI EP09-A3. However, I cannot locate any specific supporting documentation for the statements listed […]

In Vitro LA Mechanism

From Kathy Doig, PhD, Michigan State University (Go Spartans!). George – what is the current thinking on how LA interferes with our assays? Does the antibody physically block the proteins so they can’t react properly even though they embed in the phospholipids (PLs)? Does it prevent them from embedding in the PLs as they should? Or is it […]

Lupus Anticoagulant

More On Optical Versus Mechanical Clot Detection

In follow-up to Click here for the article: Cunningham et al 2012.

Instrumentation

What is an LDT?

From Kelly Townsend, Tri-core Reference Laboratories, Albuquerque. Looking for opinions on what constitutes a “Laboratory Developed Test” in Coag. Obviously if the reagent kit is not FDA-cleared, it will be an LDT, but what about factor assays, etc where there is no real kit. What if you are using a kit with a different calibrator or control […]

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George Fritsma is a medical laboratory scientist, educator, and author. George is a member of the International Society on Thrombosis and Hemostasis, the International Society for Laboratory Hematology, and the American Society for Clinical Laboratory Science.

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