Oct 24 2013

george

Rapid HIT Assays

Informal discussions with Ginger Weeden and Lucinda Lojka from Bio-Rad, Incmade me curious about rapid assays for the antibody that causes heparin-induced thrombocytopenia with thrombosis (HIT), anti-heparin/PF4. In North America we typically screen with one of three enzyme immunoassay (EIA) methods, from GTI Diagnostics Inc., Waukesha, WI, USA, PF4 Enhanced®: GTI PF4 Enhanced Package Insert; Hyphen Bio-med, Neuville-Sur-Oise, France, Zymutest HIA® Assay; or Diagnostica Stago, […]

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Anticoagulant Therapy

Oct 24 2013

george

Rivaroxaban Specimen Stability

From Soakimi Pouhila, Auckland District Health Board, New Zealand: Hi George,  any ideas on the stability of rivaroxaban in citrate samples? Hello, Soakimi Pouhila, and thank you for your question, which sent me to PubMed to see if anything has been published on rivaroxaban stability. My search was fruitless, so I’m posting your question to attract comments […]

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Anticoagulant Therapy

Oct 9 2013

george

Coag Tests for a Community Hospital

From Meg Harlin, Peninsula Regional Medical Center in Maryland: Our Laboratory will be bringing in new coagulation analyzers from Instrumentation Laboratories, Inc.; TOPS 300, in February, 2014. We currently perform prothrombin time and international normalized ratio (PT/ INR), partial thromboplastin time (APTT, PTT), fibrinogen, and D-dimer. A Few years ago we stopped doing bleeding times, mixing studies and […]

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Anticoagulant Therapy

Oct 9 2013

george

More About Oral Anticoagulants

Question from a colleague: My 92-YO dad has atrial fibrillation and is on warfarin. He is well controlled and since he is independent and drives, getting monitored is not a big deal…while the pavement is dry. However, I am worried that he will venture out when he should not during the winter when he has […]

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Anticoagulant Therapy

Oct 8 2013

george

More on INR 10.0

Thanks to Vadim Kostousov for his comments appended to the September 28, 2013 post, Accuracy of an INR of 10.0. Here are the guidelines from the latest edition of the ACCP guidelines Chest 2012 Exec Summary: 9.1 Vitamin K for Patients Taking VKAs With High INRs Without Bleeding (a) For patients taking VKAs with INRs between 4.5 and 10 […]

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Anticoagulant Therapy

Oct 8 2013

george

Quick Question: Pradaxa Measurement

Glen Holloway asks if it was possible to add “in-house dilute thrombin time” to the current Quick Question list. George promised to update this in July, and will finally keep his promise. The current Quick Question was: The new oral anticoagulants are being used more and more. How do you plan to measure dabigatran (Pradaxa) levels? […]

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Anticoagulant Therapy

Sep 28 2013

george

Accuracy of an INR of 10.0

From Eleonor Arellano: Thank you for presenting a very informative seminar, “Whatever Happened to the PT and PTT?” about the new anticoagulants last Friday at Rancho Mirage. Our ER physician is requesting the laboratory to increase the reporting of international normalized ratio (INR) of ER patients up to 10.0 INR. What are your thoughts about that? […]

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Anticoagulant Therapy

Sep 19 2013

george

Check AT Before Starting Heparin?

George,would it be better to check the patient’s antithrombin III (AT III, antithrombin, AT) level before starting unfractionated heparin (UFH)? Regards, Frances Weekes. Hi, Frances, thanks for the question, and while I’d be happy to invite other opinions from our participants, I would not recommend screening for AT levels on everyone starting unfractionated heparin for the […]

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Anticoagulant Therapy

Sep 3 2013

george

Anticoagulants and Ketogenic Diet

From Maria Jose Lauria: I would like to know if you have any experience in patients with oral anticoagulants and ketogenic diet given to patient with seizures. Hello, and thank you for yet another fascinating question. I have no experience with anticoagulation in association with the ketogenic diet in seizure disorders. A literature search reveals a […]

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Anticoagulant Therapy

Sep 2 2013

george

Rivaroxaban Measurement by Anti-Xa

Dave McGlasson forwarded Samama MM, Contant G, Spiro TE, Perzborn E, Le Flem L, Guinet C, Gourmelin Y, Rohde G, Martinoli JL. Laboratory assessment of rivaroxaban: a review. Thromb J. 2013;11:11–18, linked below. The article supports measuring rivaroxaban with the chromogenic anti-Xa assay using rivaroxaban calibrators and controls, and concedes that the prothrombin time (PT) in […]

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Anticoagulant Therapy