Anticoagulant Therapy

Anti-Xa to Replace PTT

From frequent contributor, Kim Kinney: Hi George, our Indiana University Health Pathology Laboratory is thinking of making the push again to use the Anti-Xa to monitor unfractionated (UFH) heparin therapy in place of the activated partial thromboplastin time (aPTT). I would like to hear from institutions that have made the transition successfully even in light of […]

Anticoagulant Therapy

Using the PTT After Cardiac Catheterization

This question was forwarded by an American Society for Clinical Laboratory Science Consumer Web Forum volunteer: Our hospital currently uses activated clotting time (ACT) results during heart catheterizations to monitor heparin dosage. The ACT is also used as a guide for pulling the sheath. The nurse confirms that the ACT is less than a certain […]

Anticoagulant Therapy

How Long to Stop Infusion

From Kim Kinney at Indiana University Health: Hi George. We frequently get asked how long to stop an unfractionated heparin infusion before drawing for a partial thromboplastin time (PTT) from a central line or peripheral stick above the infusion site. We have always referred them to pharmacy. is there a standard practice used by nursing at other institutions […]

Anticoagulant Therapy

Discard Tubes for Heparin?

From Dennis Ernst, Center for Phlebotomy Education, Inc: I am chairing the CLSIDocument Development Committee on the venipuncture standard revision. At today’s web meeting the question came up about the necessity for discard tubes on heparinized patients. It’s been widely reported that discard tubes are not necessary, and haven’t been for some time. However, it came to our […]

Anticoagulant Therapy

Anti-Xa versus PTT

Hi George! Our HCO is wanting to change unfractionated heparin (UFH) monitoring to the anti-Xa test from the partial thromboplastin time (PTT). The research supports decreased lenghth of stay, quicker theurapeutic range achievement and improved patient safety monitoring with anti-Xa, as many patients may appear theurapeutic with the PTT but may actually be under or […]

Anticoagulant Therapy

Pradaxa Monitoring Debate

A February 7, 2014 Heartwire article describes how Boehringer Ingelheim has released internal documents indicating their scientists had debated the need for laboratory monitoring of dabigatran.

Anticoagulant Therapy

Cortisone and Coumadin

From Prof. Jeanne Isabel, Northern Illihois University, a long-time friend and colleague. Hi George, a colleague who works at a cancer center has a patient on hydrocortisone (not sure how much) and her prothrombin time and international normalized ratio (PT/INR) were elevated to 54 s/4.9. she is on Coumadin and last time her INR was in the therapeutic […]

Anticoagulant Therapy

Discontinuing DOACs and Thrombosis

From Karen Dallas, MD, Saskatoon Health Region: I have searched the internet and cannot find a direct connection between thromboembolism prophylaxis with direct thrombin inhibitors and the induction of a prothrombotic state once discontinued. We have observed a few cases which seem to exhibit this phenomenon at my institution. Can you guide me towards any information on […]

Anticoagulant Therapy

Rivaroxaban for ACS Denied

The FDA advisory committee yesterday, January 16, 2013, unanimously withheld clearance for rivaroxaban’s acute coronary syndrome indication. Details appear in today’sMedscape Oncology Heartwire headline. This is the third time that Janssen’s application has been denied for this indication. Rivaroxaban is cleared for stroke prevention in atrial fibrillation, thrombosis prevention following total hip or knee replacement […]

Anticoagulant Therapy

Rivaroxaban for ACS?

Announcement provided by Ali Sadeghi-Khomami, PhD; Research and Development Manager, Precision BioLogic Inc: In documents released ahead of an FDA advisory panel meeting on January 16, agency staff on Tuesday expressed skepticism that the data submitted by Johnson & Johnson demonstrate that Xarelto (rivaroxaban) is effective for treating acute coronary syndrome (ACS) in patients with a previous history […]

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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