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Bivalirudin

I had promised to report some of the information we gained attending the Society for Angiography and Interventions and American College of Cardiology annual meeting held in Chicago March 29-April 1. I was particularly struck by the number of clinical trials reporting the efficacy and safety figures for bivalirudin (Angiomax) such as ISAR-REACT 3 and […]

Bleeding Time Test

From Andrea Harper: We continue to offer bleeding time testing. I would like to offer our pathologists an alternative to replace this ancient testing. In a lecture that you gave in October, 2007 in Portland, Maine, you spoke of the PFA-100. We are a 25 bed critical access facility. I’m not sure if it would […]

Alcohol and Coumadin

This question comes from the American Society for Clinical Laboratory Science Consumer Information Forum and was forwarded to Fritsma Factor by Prof. Bernadette (Bunny) Rodak of Indiana University. It is modified to mask the identity of the inquirer. “I have been on 5 mg/day of Coumadin for three months following hip replacement surgery and my […]

More on CAP and Mixing Studies

I have a question about the post regarding mixing studies and CAP checklist question 37991. (I have been trying to post this on “The Fritsma Factor” with no success.) I thought CAP question 37991 addressed appropriate plasma for mixing studies. If this is the case, is it appropriate to use lyophilized plasma for mixing? I […]

How to Establish the PTT Therapeutic Range

Hi, George, We survived the validation and are very pleased with our new Beckman-Coulter TOP, but I have an issue with the new PTT therapeutic range we established for unfractionated heparin (UFH). We collected many specimens over time, made sure they were double-spun and froze them at –70°C. Once we had the PTT validated and […]

Controls and Heparin in Mixing Studies

George: We recently had a CAP inspection and had a couple of recommendations that we’re trying to tidy up. 1. HEM 37991 regarding a control for PT mixing studies. We were using what we considered to be the normal control but were told to order the Dade Control N. I’ve ordered and just want to […]

Snakebite and D-dimer.

I am trying to discontinue the fibrin (ogen) degradation products (FDP) assay in favor of the D-dimer. I have read and used several of the posts here as references and reasons for this decision. A recent question from an ER physician has me doing some further research and I need your help. What about snake […]

The Vytorin Controversy and Surrogate Markers

The big news at the American College of Cardiology annual meeting in Chicago March 29-April 1 was the controversy caused by the ENHANCE (Effect of Combination Ezetimibe and High-Dose Simvastatin vs. Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia) trial result, essentially ending a 2 billion dollar annual market overnight. Vytorin, […]

Patient Self-testing

David Garcia, MD, president of Anticoagulation Forum reports the US Centers for Medicare and Medicaid Services (CMS) has drafted a decision to generalize patient home Warfarin monitoring. In-home PT/INR testing reimbursement has been confined to patients with mechanical heart valves. Pending a final ruling this fall, reimbursement will be extended to self-monitoring of Warfarin for […]

Protein C and S Immunoassay

I’ve never understood why protein C and protein S immunoassay results are reduced in Warfarin therapy. Because Warfarin reduces gamma-carboxylation of protein C and protein S glutamic acid units, we expect there to be reduction in activity assays but it turns out that immunoassay results are also proportionally reduced. Stephen Duff of Precision BioLogic asked […]

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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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