Jun 14 2013

george

Pradaxa Measurement: An Oxymoron?

George sent this message to Dr. David Alter, Spectrum Health System, Grand Rapids, Michigan (once named Butterworth Hospital), regarding a question he posted on MEDLAB-L on Monday, June 10, asking, “Isn’t monitoring Pradaxa an oxymoron?”: “Hi, Dr. Alter. I subscribe to MEDLAB-L and just saw your post regarding Pradaxa measurement. May I post your question and some discussion […]

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Anticoagulant Therapy

Jun 11 2013

george

What is an RUO/IUO?

We’ve had several posts about measuring the new oral anticoagulants, the most pressing concern for coagulation laboratories around the world as they are confronted with the need to determine the presence and levels of dabigatran, rivaroxaban, apixaban, and soon, edoxaban. Though pharmaceutical distributors reassure us there is no need for monitoring, we are confronted with […]

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Anticoagulant Therapy

Jun 11 2013

george

Rx Level for Dabi?

Dave McGlasson, hemostasis researcher at Wilford Hall USAF Medical Center in San Antonio, is engaged in a large-scale dabigatran measurement project. He reports that a prominent Midwestern medical center uses 45–95 ng/mL as their therapeutic range, using the plasma-diluted thrombin time (DTT, Hemoclot® direct thrombin inhibitor). In the article in Europace (2013) 15, 625–51 (posted May 9, 2013 […]

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Anticoagulant Therapy

Jun 5 2013

george

Measuring Dabi and Riva

From Kim Kinney at IU Health (formerly Clarian): Our coag lab is being asked by our heme/onc docs to have an assay for both Rivaroxaban and Dabigatran. I thought maybe you could poll your readers to see who is doing what type of assay if any! As always, thanks for your help. Hi, Kim, it is good to hear […]

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Anticoagulant Therapy

May 9 2013

george

ARISTOTLE Analysis: Apixaban Superior to Warfarin

A May 7, 2013 report from the ARISTOTLE trial was highlighted on The Heart.Organd showed superior efficacy for apixaban versus warfarin in stroke, systemic embolism, and all-cause death. The Heart.org also provided this nicely illustrated and definitive European Heart Rhythm Association guide to the use of the new oral anticoagulants, including edoxaban, the most recent direct anti-Xa inhibitor […]

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Anticoagulant Therapy

May 9 2013

george

POCT ACT and Anti-Xa for ECMO

From Deanna Miller, Point of Care Testing (POCT) Coordinator at Children’s of Alabama: We have recently merged our extracorporeal membrane oxidation (ECMO) team with the cardiovascular team from the University of Alabama at Birmingham (UAB) and we are doing all pediatric cardiovascular cases at Children’s now. We would like some insight into monitoring coagulation using the activated coagulation time […]

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Anticoagulant Therapy

May 3 2013

george

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 […]

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Anticoagulant Therapy

May 1 2013

george

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 […]

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Anticoagulant Therapy

Apr 16 2013

george

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 […]

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Anticoagulant Therapy

Apr 11 2013

george

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 […]

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Anticoagulant Therapy