Anticoagulant Therapy

Still More on Dabigatran Risks

Here is a summary of the FDA’s adverse events report suggesting a higher case fatality rate than in the Mini-Sentinel report published in the March 13, 2013 New England Journal of Medicine. The argument continues.

Anticoagulant Therapy

ACT Testing Time Interval

Here is a question from my friend and colleague Kathleen Finnegan, MS MT (ASCP )SH, Chair of the CLS program at Stony Brook University, New York. This question was posted to the ASCLS Consumer Web Forum through Lab Tests Online: “In the procedure room setting (cardiac catheterization or EP lab) what is the standard length of time to wait to […]

Anticoagulant Therapy

Dabigatran Bleeding Rate

The March 13, 2013 New England Journal of Medicine released a perspective, Dabigatran and Postmarketing Reports of Bleeding. The authors contend that early reports citing a bleeding rate higher than Coumadin may have been a symptom of intense market vigilance with over-reporting of events. Geo.

Anticoagulant Therapy

Dabigatran May Shorten Hospital Stay

The Heart.org posted a small but powerful study today illustrating that dabigatran (Pradaxa) may shorten the inpatient stay because it eliminates the need for coverage by heparin or fondaparinux and eliminates the need to tinker with dosage to hit the target international normalized ratio (INR). Yet more good new for dabigatran. Geo.

Anticoagulant Therapy

No More PT in Seconds?

From Dr. Larry Brace, Edward Hospital, Naperville, IL: I need an opinion. Here is my view on prothrombin time (PT) in seconds. We should no longer have to do a normal range for the PT in seconds. We know that the general consensus is that the international normalized ratio (INR) is considered normal to at least 1.2 […]

Anticoagulant Therapy

Triple Antithrombotic Therapy

Prof. Bernadette Rodak of Indiana University forwarded a question about parallel anticoagulant and antiplatelet therapy from the ASCLS Consumer Web Forum. In the interest of confidentiality, I paraphrase the question: “What should the international normalized ratio (INR) be when on simultaneous antiplatelet therapy (aspirin and clopidogrel) for percutaneous intervention (PCI) stent placement and anticoagulation therapy (Coumadin) […]

Anticoagulant Therapy

Rapid INR Rise in Pneumonia

From Michael Huang, MicroPoint Bio: An 80 yr old male on warfarin was admitted to A&E of a local hospital for the complaint of shortness of breath. Lab test results showed INR of 15 after his admission. Just 8 hours before, the POC instrument his doctor used to monitor his INR showed a reading of 2.6. The […]

Anticoagulant Therapy

Comparison of INR with FII, FVIII, and FX

From Dave McGlasson: George, Here is a potential answer for Kelly Townsend’s February 13 post, Factor II Assay in place of INR. Kelly is right. We did look at the chromogenic factor X and published that work a few years ago McGlasson DL, Romick BG, Rubal BL. Comparison of a chromogenic factor X assay with international normalized ratio […]

Anticoagulant Therapy

Factor II Assay in Place of INR?

From Kelly Townsend at TriCore Reference Laboratories: We have several patients in whom the INR does not appear to accurately assess their anticoagulation status. Since we do not have the chromogenic factor X assay on our menu, we’re interested in using the factor II activity assay based on a poster presented at THSNA meeting by the Univ of […]

Anticoagulant Therapy

More on PT Validation and AMR

Here’s an additional note confirming Denise Solieau’s February 12 discussion of PT validation and analytical measurable ranges (AMRs). Page 83 of the July 31, 2012 CAP survey references the value of AMRs in coagulation testing and includes this statement, “The new checklist requirements (meaning AMR) apply to hemostasis test methods that are calibrated and directly measure the concentration or […]

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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