Anticoagulant Therapy

FDA Public Workshop on DOACs

The US Food and Drug Administration has released the full transcript and video recordings of their October 26, 2015 all day public workshop, “In Vitro Diagnostic Testing for Direct Oral Anticoagulants.” The workshop features Frederick Korley, Adam Cuker, Dorothy Adcock-Funk, Robert Gosselin, Stephan Moll, and several FDA representatives. Here is the transcript: /sites/default/files/doac_testing_fda_transcript_10-26-15.pdf

Anticoagulant Therapy

Switching From Rivaroxaban to Heparin

We’ve widely acknowledged that the anti-Xa assay, currently employed to monitor heparin therapy, may be readily adapted to measuring direct oral anti-Xa antthrombotics, and at least three hemostasis diagnostics manufacturers have developed and validated rivaroxaban and apixaban calibrators and controls for this purpose. These await US FDA clearance. Meanwhile, we estimate oral anti-Xa antithrombotic efficacy […]

Anticoagulant Therapy

Kcentra Reversal of DOAC Overdose

From Gabor Varadi, MD, Albert Einstein Cancer Center, Philadelphia. I would like to ask you about Kcentra dosing for non-coumadin related indications. This would be for treating life threatening bleeding or urgent reversal prior to surgery for patients receiving targeted anticoagulants. This would only apply to the direct oral Xa antagonists, not dabigatran. Do you think […]

Anticoagulant Therapy

When to Start with Protein C and S Antigen Assay

Kristi Williams, a participant in George’s online Michigan State University (go Sparties!) graduate Hemostasis course, iasked this excellent question: I suspect practitioners in our area don’t necessarily always know or understand when the protein C and S activity vs. antigen tests should be ordered. It’s clear that protein C and S activity level assays are […]

Anticoagulant Therapy

Effect of HCT on POC INR

George received this question from the ASCLS Consumer Web Forum via Bonnie Jo Taylor, MHS, MT(ASCP)SH. I have hemochromatosis, too much iron in my blood. I’ve also had blood clots in my lungs. I peroidically undergo phlebotomy treatments to lower iron count. Will this alter the results of my INR finger prick test results? Here […]

Anticoagulant Therapy

Dabigatran Safety and Efficacy in Women

Here is an October 28, 2015 Heartwire article describing differences in dabigatran safety and efficacy between women and men.

Anticoagulant Therapy

Idarucizumab for Dabigatran Reversal Approved

On Friday, October 16, the FDA approved idarucizumab (Praxbind) as an effective reversal agent for the oral direct thrombin inhibitor, dabigatran (Pradaxa). Click here tor the press release. Thanks to Dr. Paul Riley, Stago-US, for this heads-up.

Anticoagulant Therapy

Collecting Heparin Assay Specimens from a Device

Dear George Fritsma, I work at The Valley Hospital in Ridgewood N.J. and our nursing staff has the following question about drawing an APTT from a central line/picc line when heparin is infusing. Is there a protocol of how long to stop the infusion? Also, should the first syringe be discarded? I am interested in knowing […]

Anticoagulant Therapy

USE DDAVP for Plavix Overdose

George is teaching a graduate hemostasis course for Michigan State University. In a chat room today, a participant asked if DDAVP may be used to reverse bleeding in a patient with a Plavix overdose. One of our students is a 15-year Hem-Onc who said this was an accepted ER approach. Does your facility also use […]

Anticoagulant Therapy

Platelet Count and POC PT/INR

A participant asks if point of care PT/INR results are affected by the platelet count. George responds that POC PT/INR instrument package inserts list no effects related to thrombocytopenia or thrombocytosis. Documented interferences include specimen management errors that result in partial preanalytical clotting, foaming, or hemolysis; hematocrit below 20% or above 55%, presence of coagulopathies […]

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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