Jan 16 2014

george

Rivaroxaban and Homocysteine

From our frequent contributor Crystal Azevedo, Eastern Maine Health System: Hello George, I am working up more patients taking the new directed oral anticoagulants (NOACs) for therapy. Is there a relationship between rivaroxaban and an elevated plasma homocysteine level? I have seen this more than once and I’m curious. Thanks! Hi, Crystal, this is an unexpected and […]

read more

Comments (0)

Anticoagulant Therapy

Dec 18 2013

george

Vitamin “Agonist?”

A quick note from Madan Verma: “Is there any thing such as a “vitamin agonist” and does it some how mimic factor VII deficiency? All these years I’ve read about vitamin Kantagonists (VKA) but not agonists. I came across this word while reviewing a factor VII assay done by a reference lab.” Hello, Madan Verma, and thank […]

read more

Comments (0)

Anticoagulant Therapy

Dec 12 2013

george

CoaguChek Vs. Plasma-based INR

From Joyce Low, St Vincent’s Hospital, Sydney NSW:  For those who use the Roche CoaguChek XS INR meters… At what INR would they repeat the point of care (POC) prothrombin time and international normalized ratio (PT/INR)? At what INR would they do a central laboratory (plasma-based) INR to confirm the POC INR? Regarding the correlation between CoaguChek INR […]

read more

Comments (3)

Anticoagulant Therapy

Dec 10 2013

george

DOAC Efficacy and Safety Meta-analysis

The Heart.org is now part of Medscape. Here’s a December 5, 2013 announcement:‘New’ Oral Anticoagulant Stroke-Protection Benefits in AF Cut Across Subgroups in Meta-Analysis. This is a summary of Ruff CT, Giugliano RP, Braunwald E. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised […]

read more

Comments (0)

Anticoagulant Therapy

Dec 3 2013

george

TEG or ROTEM

From Meg Hardin. George, The surgical services in our hospital are requesting that we look into purchasing the Thromboelastograph (TEG) or Rotational Thromboelastometry System (ROTEM) in order to decrease blood utilization. TEG representatives tell surgical services that they can receive results with in 2 minutes of the blood being placed on the analyzer. I know nothing (except what I read) […]

read more

Comments (7)

Anticoagulant Therapy

Nov 12 2013

george

Quick Question: Measuring Dabigatran

This question was a reprise of an earlier question and attracted relatively few votes, however it added “In-house dilute thrombin time,” which turns out to be used by several laboratories. What assay do you use to measure dabigatran (Pradaxa)? a. Stago’s ecarin chromogenic assay, 4 (31%) b. Standard thrombin time, 3 (23%) c. In-house dilute […]

read more

Comments (0)

Anticoagulant Therapy

Nov 8 2013

george

Warfarin Reversal with 4-Factor PCC

Here is an audio blog by Dr. Samuel Goldhaber describing KCentra, the four-factor prothrombin complex concentrate cleared in March of 2013 for reversal of Coumadin overdose. KCentra has been available for several years in Europe using the trademark Beriplex.

read more

Comments (0)

Anticoagulant Therapy

Nov 8 2013

george

New FDA LMWH Guidelines

Elaine Benoit of Precision BioLogic Inc forwarded a November 6, 2013 message recommending new spinal catheter insertion and removal times for patients receiving low molecular weight heparin (LMWH) such as enoxaparin (Lovenox or generics). To avoid spinal bleeds, the FDA now recommends discontinuing LMWH treatment and delaying procedures by 12 hours when using a prophylactic dose and 24 hours when […]

read more

Comments (0)

Anticoagulant Therapy

Nov 8 2013

george

Pre-Surgical Screening

Prof. Jeanne Isabel, Medical Laboratory Science Program Director, Northern Illinois University, forwarded the following question, posted to the American Society for Clinical Laboratory Science Consumer Forum: “We run prothrombin time assays with international normalized ratios (PT/INRs) on most all patients pre-procedure regardless of whether they take Coumadin or heparin. I have done some research and this is the […]

read more

Comments (5)

Anticoagulant Therapy

Oct 30 2013

george

Mixing Studies After Fonda

Hi George, We have a question about performing mixing studies following fondaparinux or enoxaparin administration. How long do you recommend waiting (# half lifes) to perform mixing studies after these medications are administered? Thanks, Carla Purvis,Parkview Regional Medical Center, Fort Wayne, IN. Hi, Carla, and thank you for the question. Enoxaparin has a 4-hour half-life and […]

read more

Comments (1)

Anticoagulant Therapy