Anticoagulant Therapy

New DOAC Reversal Agents

George, I noticed on Fritsma Factor the question on using Kcentra to reverse DOACs. I just got this off Medscape on a phase 3 study of an antidote to the factor Xa inhibitor apixaban. An IV bolus of andexanet alfa immediately and significantly reversed apixaban in 33 healthy volunteers enrolled in the ANNEXA-A study. The authors […]

Anticoagulant Therapy

KCentra to Reverse DOACs?

From Gabor Varadi, Einstein Healthcare: Hello George, I would like to ask your opinion about using 4-component prothrombin complex concentrate (PCC) for rivaroxaban and dabigatran-induced life-threatening bleeding. Any scientific data to support using this product? Thank you. Hello, Dr. Varadi, and thank you for your question. Kcentra, from CLS Behring, has been available since 2009 under the trademark […]

Anticoagulant Therapy

Pediatric INR?

From Patti Richardson, St. Christopher’s Hospital for Children: Good afternoon, George: For critical values, are pediatric hospitals using the prothrombin time and international normalized ratio (PT & INR)? For pediatric hospitals, what is the INR critical value most often used? Hello, Patti, thank you for an excellent question. The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American […]

Anticoagulant Therapy

Dabigatran Controversy

Here is a Medpage article that broke July 23 describing the concern that Boehringer Ingelheim may have withheld data that supported dabigatran measurement in atrial fibrillation treatment. For the details, see Reilly PA, Lehr T, Haertter S, et al. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation […]

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

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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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