Jan 28 2014

george

Discontinuing DOACs and Thrombosis

From Karen Dallas, MD, Saskatoon Health Region: I have searched the internet and cannot find a direct connection between thromboembolism prophylaxis with direct thrombin inhibitors and the induction of a prothrombotic state once discontinued. We have observed a few cases which seem to exhibit this phenomenon at my institution. Can you guide me towards any information on […]

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Anticoagulant Therapy

Jan 17 2014

george

Rivaroxaban for ACS Denied

The FDA advisory committee yesterday, January 16, 2013, unanimously withheld clearance for rivaroxaban’s acute coronary syndrome indication. Details appear in today’sMedscape Oncology Heartwire headline. This is the third time that Janssen’s application has been denied for this indication. Rivaroxaban is cleared for stroke  prevention in atrial fibrillation, thrombosis prevention following total hip or knee replacement […]

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Anticoagulant Therapy

Jan 16 2014

george

Rivaroxaban for ACS?

Announcement provided by Ali Sadeghi-Khomami, PhD; Research and Development Manager, Precision BioLogic Inc: In documents released ahead of an FDA advisory panel meeting on January 16, agency staff on Tuesday expressed skepticism that the data submitted by Johnson & Johnson demonstrate that Xarelto (rivaroxaban) is effective for treating acute coronary syndrome (ACS) in patients with a previous history […]

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Anticoagulant Therapy

Jan 16 2014

george

Rivaroxaban and Homocysteine

From our frequent contributor Crystal Azevedo, Eastern Maine Health System: Hello George, I am working up more patients taking the new directed oral anticoagulants (NOACs) for therapy. Is there a relationship between rivaroxaban and an elevated plasma homocysteine level? I have seen this more than once and I’m curious. Thanks! Hi, Crystal, this is an unexpected and […]

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Anticoagulant Therapy

Dec 18 2013

george

Vitamin “Agonist?”

A quick note from Madan Verma: “Is there any thing such as a “vitamin agonist” and does it some how mimic factor VII deficiency? All these years I’ve read about vitamin Kantagonists (VKA) but not agonists. I came across this word while reviewing a factor VII assay done by a reference lab.” Hello, Madan Verma, and thank […]

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Anticoagulant Therapy

Dec 12 2013

george

CoaguChek Vs. Plasma-based INR

From Joyce Low, St Vincent’s Hospital, Sydney NSW:  For those who use the Roche CoaguChek XS INR meters… At what INR would they repeat the point of care (POC) prothrombin time and international normalized ratio (PT/INR)? At what INR would they do a central laboratory (plasma-based) INR to confirm the POC INR? Regarding the correlation between CoaguChek INR […]

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Anticoagulant Therapy

Dec 10 2013

george

DOAC Efficacy and Safety Meta-analysis

The Heart.org is now part of Medscape. Here’s a December 5, 2013 announcement:‘New’ Oral Anticoagulant Stroke-Protection Benefits in AF Cut Across Subgroups in Meta-Analysis. This is a summary of Ruff CT, Giugliano RP, Braunwald E. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised […]

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Anticoagulant Therapy

Dec 3 2013

george

TEG or ROTEM

From Meg Hardin. George, The surgical services in our hospital are requesting that we look into purchasing the Thromboelastograph (TEG) or Rotational Thromboelastometry System (ROTEM) in order to decrease blood utilization. TEG representatives tell surgical services that they can receive results with in 2 minutes of the blood being placed on the analyzer. I know nothing (except what I read) […]

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Anticoagulant Therapy

Nov 12 2013

george

Quick Question: Measuring Dabigatran

This question was a reprise of an earlier question and attracted relatively few votes, however it added “In-house dilute thrombin time,” which turns out to be used by several laboratories. What assay do you use to measure dabigatran (Pradaxa)? a. Stago’s ecarin chromogenic assay, 4 (31%) b. Standard thrombin time, 3 (23%) c. In-house dilute […]

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Anticoagulant Therapy

Nov 8 2013

george

Warfarin Reversal with 4-Factor PCC

Here is an audio blog by Dr. Samuel Goldhaber describing KCentra, the four-factor prothrombin complex concentrate cleared in March of 2013 for reversal of Coumadin overdose. KCentra has been available for several years in Europe using the trademark Beriplex.

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Anticoagulant Therapy