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

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

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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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