Anticoagulant Therapy

Xarelto and D-dimer

George and Dr. Louann Lawrence have been communicating with a patient through the ASCLS Consumer Web Forum who experienced a DVT and PE in 2014 and has been on Xarelto since then. Her physician routinely orders a D-dimer to assess the risk of a recurrence after discontinuing Xarelto. The patient stops Xarelto for 24 hours […]

Anticoagulant Therapy

Bivalirudin and Ecarin Clotting Time

Maria Grana asks, who uses the ecarin clotting test? Can the ecarin clotting test be used for bivalirudin (Angiomax) monitoring? Is the ecarin clotting test FDA approved? We are having complaints from MDs that the activated clotting time (ACT) is not responding to administration of heparin on some patients. Can these patients have antithrombin (AT, […]

Anticoagulant Therapy

ACT Cuvettes

From Lesa Nelson, who was a graduate student in George’s fall, 2015 Michigan State University Hemostasis and Thrombosis and Resource Management online graduate course. Our cardiac catheterization laboratory performed an ACT using the Hemochron ACT+ cuvette, designed to measure the effects of 1–6 U/mL (high dose) heparin. They were getting ACT results of 149–190 seconds […]

Anticoagulant Therapy

Repeat SRA Testing

From Julia: Hi George, Our physicians order repeat serotonin release assay (SRA) testing on the same patients during the same hospitalization after heparin therapy has been stopped. Sometimes the physicians order within hours. We have called and asked if they are duplicates and they insist they need this testing. Is there research or literature to […]

Anticoagulant Therapy

Rocket AF Controversy

It appears the often-criticized Rocket AF clinical trial, the results of which the FDA used to approve rivaroxaban (Xarelto), may have been flawed by the use of the Alere INRatio2 PT/INR point of care device in its Coumadin arm, recalled by the FDA in January of 2015. Read more in Medscape.

Anticoagulant Therapy

Clinical VTE Guidance

The Anticoagulation Forum has published a special issue of the Journal of Thrombosis and Thrombolysis, Volume 41; Management of Venous Thromboembolism: Clinical Guidance from the Anticoagulation Forum. The issue, consisting of 12 articles, is free online. The Forum also offers a free noon, EST March 3 webinar, Guidance for the Prevention and Treatment of Cancer-Associated […]

Anticoagulant Therapy

Anti-Xa Result is Zero

From Jennifer Watson, Centracare Health: Hello, What are your recommendations when an anti factor Xa returns with a value of 0, even after increasing doses several times? Thank you. Hello, Jennifer, and thank you for this question. Assuming the heparin dosing has been administered correctly, you may be seeing a patient who has acquired, or […]

Anticoagulant Therapy

Monitoring UFH With In Vivo Hemolysis

From Andrew Goodwin, MD, University of Vermont: Hey George, I am wondering if you have experience with in-vivo hemolysis following AnigioJet mechanical pharmacothrombectomy using TPA. We had two patients over the past week in which in-vivo hemolysis was moderate to severe. In our first patient, the hemolysis was not immediate; it appeared about 12 hours […]

Anticoagulant Therapy

Anticoagulation Webinar 1-27-16

The International Society on Thrombosis and Haemostasis presents an ISTH Academy Webinar: Monitoring of Anticoagulation reaturing Adam Cuker, MD, and Gualtiero Palareti, MD, Wednesday, January 27, 15–1600 UTC. The webinar is free to ISTH members.

Anticoagulant Therapy

FDA Public Workshop on POC PT/INR

The US Food and Drug administraion will offer a public workshop, “Point of Care Prothrombin Time/International Normalized Ratio Devices for Monitoring Warfarin Therapy,” March 18, 2016 at their White Oak Campus, 10903 New Hampshire Avenue, Silver Spring, MD.

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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