Nov 8 2013

george

New FDA LMWH Guidelines

Elaine Benoit of Precision BioLogic Inc forwarded a November 6, 2013 message recommending new spinal catheter insertion and removal times for patients receiving low molecular weight heparin (LMWH) such as enoxaparin (Lovenox or generics). To avoid spinal bleeds, the FDA now recommends discontinuing LMWH treatment and delaying procedures by 12 hours when using a prophylactic dose and 24 hours when […]

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Anticoagulant Therapy

Nov 8 2013

george

Pre-Surgical Screening

Prof. Jeanne Isabel, Medical Laboratory Science Program Director, Northern Illinois University, forwarded the following question, posted to the American Society for Clinical Laboratory Science Consumer Forum: “We run prothrombin time assays with international normalized ratios (PT/INRs) on most all patients pre-procedure regardless of whether they take Coumadin or heparin. I have done some research and this is the […]

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Anticoagulant Therapy

Oct 30 2013

george

Mixing Studies After Fonda

Hi George, We have a question about performing mixing studies following fondaparinux or enoxaparin administration. How long do you recommend waiting (# half lifes) to perform mixing studies after these medications are administered? Thanks, Carla Purvis,Parkview Regional Medical Center, Fort Wayne, IN. Hi, Carla, and thank you for the question. Enoxaparin has a 4-hour half-life and […]

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Anticoagulant Therapy

Oct 24 2013

george

Rapid HIT Assays

Informal discussions with Ginger Weeden and Lucinda Lojka from Bio-Rad, Incmade me curious about rapid assays for the antibody that causes heparin-induced thrombocytopenia with thrombosis (HIT), anti-heparin/PF4. In North America we typically screen with one of three enzyme immunoassay (EIA) methods, from GTI Diagnostics Inc., Waukesha, WI, USA, PF4 Enhanced®: GTI PF4 Enhanced Package Insert; Hyphen Bio-med, Neuville-Sur-Oise, France, Zymutest HIA® Assay; or Diagnostica Stago, […]

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Anticoagulant Therapy

Oct 24 2013

george

Rivaroxaban Specimen Stability

From Soakimi Pouhila, Auckland District Health Board, New Zealand: Hi George,  any ideas on the stability of rivaroxaban in citrate samples? Hello, Soakimi Pouhila, and thank you for your question, which sent me to PubMed to see if anything has been published on rivaroxaban stability. My search was fruitless, so I’m posting your question to attract comments […]

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Anticoagulant Therapy

Oct 9 2013

george

Coag Tests for a Community Hospital

From Meg Harlin, Peninsula Regional Medical Center in Maryland: Our Laboratory will be bringing in new coagulation analyzers from Instrumentation Laboratories, Inc.; TOPS 300, in February, 2014. We currently perform prothrombin time and international normalized ratio (PT/ INR), partial thromboplastin time (APTT, PTT), fibrinogen, and D-dimer. A Few years ago we stopped doing bleeding times, mixing studies and […]

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Anticoagulant Therapy

Oct 9 2013

george

More About Oral Anticoagulants

Question from a colleague: My 92-YO dad has atrial fibrillation and is on warfarin. He is well controlled and since he is independent and drives, getting monitored is not a big deal…while the pavement is dry. However, I am worried that he will venture out when he should not during the winter when he has […]

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Anticoagulant Therapy

Oct 8 2013

george

More on INR 10.0

Thanks to Vadim Kostousov for his comments appended to the September 28, 2013 post, Accuracy of an INR of 10.0. Here are the guidelines from the latest edition of the ACCP guidelines Chest 2012 Exec Summary: 9.1 Vitamin K for Patients Taking VKAs With High INRs Without Bleeding (a) For patients taking VKAs with INRs between 4.5 and 10 […]

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Anticoagulant Therapy

Oct 8 2013

george

Quick Question: Pradaxa Measurement

Glen Holloway asks if it was possible to add “in-house dilute thrombin time” to the current Quick Question list. George promised to update this in July, and will finally keep his promise. The current Quick Question was: The new oral anticoagulants are being used more and more. How do you plan to measure dabigatran (Pradaxa) levels? […]

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Anticoagulant Therapy

Sep 28 2013

george

Accuracy of an INR of 10.0

From Eleonor Arellano: Thank you for presenting a very informative seminar, “Whatever Happened to the PT and PTT?” about the new anticoagulants last Friday at Rancho Mirage. Our ER physician is requesting the laboratory to increase the reporting of international normalized ratio (INR) of ER patients up to 10.0 INR. What are your thoughts about that? […]

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Anticoagulant Therapy