Anticoagulant Therapy

Anticoagulant Reversal Protocols

From Scott Cornelius at Johnson & Johnson, I am interested in finding out if you have any samples of what good bleeding protocols for large teaching hospitals are like. With all of the new oral agents on the market there surely are many new challenges in managing patients with ICH and other serious bleeding complications. Thanks for your […]

Anticoagulant Therapy

INR Reference Range?

A message from Patti Richardson and Dr. Manjula Balasubramanian, St Christopher’s Hospital for Children, Philadelphia, PA (originally posted November, 2011): Is it necessary to have a reference range for the international normalized ratio (INR)? It is a calculated value. If so, should these be derived from the normal prothrombin time (PT) ranges? The Heme CAP checklist does not […]

Anticoagulant Therapy

POC INRs with an APA

From Elizabeth Kreuser: Our pharmacy is using a point of care (POC) device to monitor prothrombin times with international normalized ratios (INRs). However, they have a patient with an anti-phospholipid antibody (APA). We did a quick study using Stago Neoplastin Cl Plus, Stago clotting factor II, and the POC device. Results were: Assay Test 1 Test […]

Anticoagulant Therapy

New Oral A/Cs and POC

A message from Crystal Azevedo, Eastern Maine Medical Center: Hello George, I have a question regarding the new Xa inhibitors and dabigatran and point of care (POC) systems. Is there any known interference in the prothrombin time/international normalized ratio (PT/INR) determination of POC assays when a patient is on one of these medications? We are using the […]

Anticoagulant Therapy

Omaha Presentation Handouts

George substituted for Dave McGlasson and presented, “Monitoring the New Antithrombotics: Whatever Happened to the PT and PTT?” on Wednesday, April 3, 10 AM; and “Antiplatelet Therapy, Do Aspirin and Plavix Work?” on Thursday, April 3, 2:30–2:30 PM at the Great Plains Regional Laboratory Expo in Omaha Nebraska. His presentation handouts, in PDF, appear on our Audio Modules page. Thanks […]

Anticoagulant Therapy

Does Apixaban Affect Clot-based Assays?

From Linda Stang, Alberta Health Services: As apixaban (Eliquis) is sure to start wreaking havoc in some of our special coag assays (read: tests will be ordered while patients are on this drug, but they WON’T tell us…), I did a search for publications about apixaban interference, and found nothing. Does anyone have any experience with interference […]

Anticoagulant Therapy

New Rivaroxaban Indication in Europe

On Friday, March 22 the European Medicines Agency Committee for Medicinal Products for Human Use cleared rivaroxaban (Xarelto) for prevention of atherothrombotic events in patients with acute coronary syndrome. EMA made this decision a few weeks after the US FDA disapproved the drug for the same indication. The news release appears on TheHeart.org.

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

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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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