Anticoagulant Therapy

Discontinue Coumadin?

George is seeking advice on behalf of a colleague. A 78-YO male patient with atrial fibrillation on Coumadin >20 years experiences a large bruise following a fall. The INR is 1.8. The patient also has Parkinson disease >10 years. Would you discontinue Coumadin? Would you propose alternative antithrombotic therapy? Thank you.

Anticoagulant Therapy

Assays for Direct Oral Anticoagulants

From Lisa Bakken: I am a part of a stroke committee at my hospital that needs/wants to implement anti-factor Xa and anti-factor IIa testing for the new oral anticoagulants (NOACs). In addition to this, our laboratory is looking into new coag instrumentation. We are struggling to determine what is the best for our patient population. Our […]

Anticoagulant Therapy

US FDA: Pradaxa Profile

Thanks to Elaine Benoit at Precision BioLogic for this heads-up on the results of a new study describing dabigatran (Pradaxa) efficacy and safety outcomes in an older population, including a description of the risks of GI bleeding.

Anticoagulant Therapy

More on Heparin Monitoring

From Vanessa Chan at Sick Kids in Toronto: Hi George and the coag world, what assay is everyone using to monitor unfractionated heparin (UFH) and low molecular weight heparin (LMWH)? What are everyone’s thoughts on the use of antithrombin and/or dextran sulfate in these reagents? In your external quality assessments (EQAs), do you experience any biased results with your […]

Anticoagulant Therapy

Anti-Xa; Do You Still Offer PTT?

From Kim Kinney, Indiana University, Hi George, one question leads to another. We have a meeting tomorrow (Tuesday, May 6) with our anticoagulation committee and one question that I think will come up will be, if we do convert to the chromogenic anti-Xa method for monitoring heparin, will we still maintain the therapeutic partial thromboplastin time […]

Anticoagulant Therapy

Validate Anti-Xa for Heparin Therapeutic Range?

If I wanted to perform an anti-Xa assay to determine my therapeutic range for my new lot of partial thromboplastin time (PTT) reagent, does the Xa need to be a validated test on my analyzer? Hello, and yes, the reference method must be validated to insure the PTT therapeutic range is valid. If you aren’t […]

Anticoagulant Therapy

TEG for LMWH?

While attending the American Society for Clinical Laboratory Science (ASCLS)-Michigan annual meeting in Kalamazoo, I met Beth Friedt, MSA, MT (ASCP), Administrative Director of the Clinical Laboratory at Hurley Medical Center, Flint, Michigan. She asked if thromboelastography (TEG) or thromboelastometry (TEM) has been used to measure low molecular weight heparin (LMWH) therapy. I knew of no instance where it was […]

Anticoagulant Therapy

Anti-Xa to Replace PTT

From frequent contributor, Kim Kinney: Hi George, our Indiana University Health Pathology Laboratory is thinking of making the push again to use the Anti-Xa to monitor unfractionated (UFH) heparin therapy in place of the activated partial thromboplastin time (aPTT). I would like to hear from institutions that have made the transition successfully even in light of […]

Anticoagulant Therapy

Using the PTT After Cardiac Catheterization

This question was forwarded by an American Society for Clinical Laboratory Science Consumer Web Forum volunteer: Our hospital currently uses activated clotting time (ACT) results during heart catheterizations to monitor heparin dosage. The ACT is also used as a guide for pulling the sheath. The nurse confirms that the ACT is less than a certain […]

Anticoagulant Therapy

How Long to Stop Infusion

From Kim Kinney at Indiana University Health: Hi George. We frequently get asked how long to stop an unfractionated heparin infusion before drawing for a partial thromboplastin time (PTT) from a central line or peripheral stick above the infusion site. We have always referred them to pharmacy. is there a standard practice used by nursing at other institutions […]

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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