FDA Clears Edoxaban

On Thursday, January 8, 2014, the FDA cleared edoxaban (Savaysa, Daiichi-Sankyo) for reducing risk of ischemic stroke in non-valvular atrial fibrillation (AFIB) and for treating DVT and PE in patients who have already been receiving an anticoagulant by injection or by infusion for 5 to 10 days. The anticoagulant joins apixaban and rivaroxaban as the […]

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Anticoagulant Therapy

Nov 21 2014

george

Coumadin and Factor Half-lives

I received a question recently about Coumadin (warfarin) therapy and coagulation factor half-lives. Coumadin reduces the normal carboxylation of the glutamic acid γ-carbon. There are 12–18 glutamic acid units near the amino terminus of the vitamin K-dependent factors II (prothrombin), VII, IX, and X. When vitamin K-catalyzed γ-carboxylation becomes suppressed, these coagulation factors are unable […]

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Anticoagulant Therapy

Nov 1 2014

george

Favorable FDA Edoxaban Vote

According to an October 30 Medscape post, Edoxaban (Savaysa, Daiichi-Sankyo) received a favorable vote, 9–1, in favor of release for once a day treatment at 30 and 60 mg to prevent non-valvular atrial fibrillation ischemic stroke. Edoxaban was found non-inferior to “in control” Coumadin in patients with mild to moderate renal impairment, but its performance in […]

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Anticoagulant Therapy

Oct 16 2014

george

Test to Assess Clotting Status

From our ASCLS Consumer Web Forum: I was wondering if there is any test available to assess the clotting status of someone with factor V Leiden genetic disorder to verify if the treatment plan has been effective? If the patient has been on anticoagulants, is there a test to prove that the blood-clotting issue has […]

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Anticoagulant Therapy

Oct 6 2014

george

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 […]

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Anticoagulant Therapy

Oct 5 2014

george

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 […]

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Anticoagulant Therapy

Sep 25 2014

george

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 […]

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Anticoagulant Therapy

Jul 24 2014

george

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 […]

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Anticoagulant Therapy

Jul 15 2014

george

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.

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Anticoagulant Therapy

Jun 19 2014

george

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 […]

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Anticoagulant Therapy

Anticoagulant Therapy

FDA Clears Edoxaban

Coumadin and Factor Half-lives

Favorable FDA Edoxaban Vote

Test to Assess Clotting Status

New DOAC Reversal Agents

KCentra to Reverse DOACs?

Pediatric INR?

Dabigatran Controversy

Discontinue Coumadin?

Assays for Direct Oral Anticoagulants

George Fritsma MS MLS

Cheat Sheets from George

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