Anticoagulant Therapy

May, 2018 Quick Question: DOACs

Our May, 2018 Quick Question asks, “How do you measure the oral anti-Xa anticoagulants rivaroxaban, apixaban, edoxaban, and betrixaban?” Here are the answers from our 89 respondents. Prothrombin time (PT): 4 (4%) Activated partial thromboplastin time (APTT, PTT): 3 (3%) Chromogenic anti-Xa assay with specific calibrators: 44 (49%) We don’t measure the anti-Xa anticoagulants: 38 […]

Anticoagulant Therapy

AndexXa

On May 4, the FDA approved andexanet alpha (AndexXa, Portola Pharmaceuticsls) as the first and only reversal agent for direct anti-Xa DOACs rivaroxaban (Xarelto), and apixaban (Eliquis) overdose. Tap or click MD Magazine for details. Also see the ANEXXA-A report in Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa for the reversal of […]

Anticoagulant Therapy

Activated Clotting Time

Please help me (George) learn if the ACT is used for any purpose other than monitoring high dose intravenous heparin during coronary artery bypass graft surgery, percutaneous intervention, ablations, and for monitoring protamine sulfate heparin reversal at the end of the cardiac procedure. Does anyone use the ACT for routine heparin therapy monitoring or for […]

Anticoagulant Therapy

April, 2018 QQ: Dabigatran Assay

Here are the responses to our April, 2018 Quick Question, “How do you measure the oral direct thrombin inhibitor dabigatran?” Standard thrombin time: 7 votes, 8% Activated partial thromboplastin time (APTT, PTT): 5 votes, 5% Chromogenic ecarin clotting time assay: 9 votes, 10% HEMOCLOT thrombin inhibitor assay (plasma-diluted thrombin time): 17 votes, 18% We don’t […]

Anticoagulant Therapy

April Quick Question: Dabigatran Measurement

Our April, 2018 Quick Question is now available. Please select the answer closest to your practice, or send your comment to George at [email protected]. Here is a current article that addresses measurement of all DOACS: Gosselin RC, Adcock DM, Bates SM, et al. International Council for Standardization in Haematology (ICSH) Recommendations for Laboratory Measurement of […]

Anticoagulant Therapy

Xarelto Bleeding Intensity

George communicated with an acquaintance who experienced Coumadin therapy a few years ago and, subsequent to a new DVT, is now on Xarelto. He notes that minor cuts bleed longer and more profusely when on Xarelto compared to Coumadin. Can any of our subscribers confirm this?

Anticoagulant Therapy

Geometric V. Arithmetic Mean

From Dave McGlasson, does anyone have a reference on why a geometric mean is used in the INR calculation? Since we are using 20–30 normal subjects to calculate the mean PT, the range is relatively narrow. The geometric mean indicates the central tendency or typical value of a set of numbers by using the product of […]

Anticoagulant Therapy

POC and Plasma-based PT/INRs

We’ve had a number of discussions comparing point of care PT/INR results with central laboratory plasma-based PT/INRs. The December, 2017 CAP Today featured this issue in their cover article, Hemostasis, Two Hot-button Testing Issues. The first half of the article reviewed the need for age-adjusted D-dimer reference intervals for ruling out DVT and PT, and […]

Anticoagulant Therapy

When to Collect Thrombophilia Specimens

George has been communicating with Drs. Elaine Keohane (Rutgers) and Larry Smith (Abbott) about how long to wait after a thrombotic event to collect a specimen for a thrombosis risk profile. Thrombosis risk profiles include assays for antithrombin, protein C, and protein S deficiencies, which can’t be accurately measured during periods of acute inflammation (such […]

Anticoagulant Therapy

Antithrombin Deficiency Affects Heparin Assays

Another important issue addressed by Dr. James Quesenberry, St. Luke’s Laboratory, Sioux City, Iowa. His message: I understood from early on that antithrombin (AT, antithrombin III, ATIII) deficient patients can’t be assayed for unfractionated heparin using the Stago chromogenic anti-Xa heparin assay. I thought this was an all-or-none issue, only a big deal in congenital […]

Anticoagulant Therapy

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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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