Mar 28 2026

george

April 2026 QQ: VWF Activity

Our April 2026 QQ, “How do you measure VWF activity,” reprises our February 2023 QQ that asked: “What VWF Activity Assay do you use?” Discussions at the March 2026 THSNA meeting in Portland, Oregon, USA, have prompted me (Geo) to learn if our choices have changed in three years. We await new data for the […]

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Anticoagulant Therapy

Mar 28 2026

george

March 2026 QQ: LAC Assay

Our March 2026 Quick Question was a poll that asked: “How do you test for LAC when the patient is on a DOAC?” Our 19 respondents answered: Don’t test: 3 (15%) Go ahead and test: 2 (11%) Use a DOAC neutralizer: 12 (63%) Test only for anticardiolipin antibody and anti-Β2GP1: 2 (11%) The DOAC neutralizers […]

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Anticoagulant Therapy

Mar 24 2026

george

Global Anticoagulant Supply

Here is an open-access editorial describing a critical worldwide shortage of safe therapeutic anticoagulants. Fan BE, Yee Tang JK, Favaloro EJ. Safeguarding global anticoagulant supply and access. J Thromb Haemost. 2026:S1538-7836(26)00134-0. doi: 10.1016/j.jtha.2026.02.017. PMID: 41791674. Abstract Anticoagulants are essential to healthcare, yet their global supply is inherently fragile. Reliance on animal-derived heparin creates vulnerability to […]

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Anticoagulant Therapy

Mar 15 2026

george

Review and History: Protamine and Gene Therapy

Here is a provocative article available from your medical library: Thachil J. Protamine–the journey from DNA to heparin neutralization to gene therapy. Semin Thromb Hemost. 2022;48:240-243. doi: 10.1055/s-0041-1736574. PMID: 34729729. Abstract Protamine is now well recognized as a key heparin-neutralizing agent. However, protamine was discovered over a century ago, during experiments performed to uncover the […]

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Anticoagulant Therapy

Mar 10 2026

george

Anticoagulant Monitoring in ECMO

Here’s a provocative open-access essay that reviews the efficacy of current anticoagulant monitoring in ECMO: Rajsic S, Treml B. Anticoagulation monitoring during ECMO support: monitor or flip a coin? Clin Cardiol. 2024;47(12):e70061. doi: 10.1002/clc.70061. PMID: 39692163; PMCID: PMC11653157. Abstract Should we rely on anticoagulation monitoring in ECMO patients or simply flip a coin? The increasing […]

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Anticoagulant Therapy

Mar 5 2026

george

Xarelto Sales Decline

Bayer said Wednesday 3-4-26 that it expects the erosion of Xarelto sales to “slightly accelerate” this year as the oral anticoagulant faces further competition from generics. Revenue from the product is forecast to fall by between 35% and 40% in 2026, compared to a roughly 33% decline last year to €2.3 billion ($2.7 billion). The company […]

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Anticoagulant Therapy

Mar 2 2026

george

Bleeding and Thrombosis in Chronic Kidney Disease

Click this open-access article on the adverse outcomes of anticoagulation in chronic kidney disease: Jones A, Swan D, Lisman T, Barnes GD, Thachil J. Anticoagulation in chronic kidney disease: current status and future perspectives. J Thromb Haemost. 2024;22:323–36. doi: 10.1016/j.jtha.2023.09.020. PMID: 37778512. Abstract Chronic kidney disease (CKD) is being diagnosed increasingly worldwide. It is often […]

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Anticoagulant Therapy

Feb 27 2026

george

March 2026 QQ: LAC Testing When the Patient is on DOAC

Our March 2026 Quick Question is a poll that asks, “How do you test for LAC when the patient is on a DOAC?” This question arises from the discussion in our 2-19-26 post, “CAP Today: Hemostasis Testing While on DOACs.” Often, the provider requests LAC testing for a thrombosis patient on anticoagulation. While the anticoagulant […]

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Anticoagulant Therapy

Feb 27 2026

george

February 2026 QQ Results: DOAC Names

Our February 2026 Quick Question was a quiz that drew 42 responses. The stem asked, “Which DOAC is a direct thrombin inhibitor?” Your answers: Apixaban: 9 (21%) Betrixaban: 0 Dabigatran: 32 (76%) Edoxaban: 0 Rivaroxaban: 1 (3%) We performed well on this question. No one chose betrixaban, an FXa-directed oral anticoagulant that was withdrawn in […]

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Anticoagulant Therapy

Feb 25 2026

george

Diagnostic Equity Question: INR is 3.9

This question appeared 2-24-26 on the Diagnostic Equity website: “I’m on warfarin for atrial fibrillation, and my INR today is 3.9. The target range is 2.0–3.0. I haven’t changed my diet or missed any doses. What factors could cause my INR to drift this high unexpectedly, and when does an elevated INR become an emergency?” […]

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Anticoagulant Therapy