May 25 2012

george

When is Pradaxa Preferred over Warfarin?

Here is a question from Farah Quresh in follow-up to a presentation on antithrombotics that George made May 24 during “Bioconference Live“: What are the conditions in which Pradaxa is preferred over warfarin? Thank you. Hello, and thank you for your question. This is a clinical judgment call that a physician may use based on economics, ability […]

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Anticoagulant Therapy

May 25 2012

george

Bioconference Presentation Handout: Monitoring New A/Cs

Yesterday, Thursday, May 24 I had the pleasure of presenting “Monitoring the New Anticoagulants; Whatever Happened to the PT and PTT?” for Bioconference Live. Registration for the conference is free, the presentations were recorded and are available through August, 2012. In a chat room after the conference I promised Warren Coffin, Crozer Chester Medical Center, Philadelphia, a […]

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Anticoagulant Therapy

May 24 2012

george

Rivaroxaban Setback

Yesterday, May 23, the FDA Cardiovascular and Renal Drugs Advisory Committee failed to endorse the use of rivaroxaban (Xarelto, Bayer) for acute coronary syndrome. SeeTheHeart.org for details.

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Anticoagulant Therapy

May 24 2012

george

HIT Kits

From Ginger Weeden, MLS (ASCP)cm, Bio-Rad Laboratories: George, What heparin-induced thrombocytopenia with thrombosis (HIT) testing is available in the US? I’m wondering how many manufacturers there are. Thanks for any information. Hi, Ginger, and thanks for your question. All the C14 serotonin release assay methods (washed platelets) available from reference labs are laboratory-developed tests. Here are the manufacturers I […]

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Anticoagulant Therapy

May 16 2012

george

Who Uses the Hybrid Curve?

Most of us have maintained separate calibration (reference) curves for our chromogenic anti-Xa heparin assays, one each for standard unfractionated heparin (UFH) and low molecular weight heparin (LMWH, enoxaparin, Lovenox), and more recently, the synthetic pentasaccharide, fondaparinux (fonda, Arixtra). Frequent contributor (friend and colleague) Dave McGlasson (Wilford Hall USAF Medical Center) has published two articles on the […]

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Anticoagulant Therapy

May 16 2012

george

QQ: Reflexing POC INRs

Here are the responses to our May, 2012 quick question: When using point of care testing, at what INR does your anticoagulation clinic require a confirmatory plasma-based (conventional) PT? a. 4.0: 34 (65%) b. 5.0: 9 (17%) c. 6.0: 4 (8%) d. Never: 5 (10%) Our responses closely parallel our April 24 and May 7 discussions; […]

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Anticoagulant Therapy

May 16 2012

george

Does Altitude or Alcohol Affect the INR?

From an inquirer to the American Society for Clinical Laboratory Science Consumer Forum (with permission): I have a titanium aortic valve. I sometimes experience atrial fibrillation (afib). My cardiologist wants my prothrombin time/international normalized ratio (PT/INR) to be 2.5–3.5. I take 5 mg daily of warfarin. One day per week I take 7.5 mg. I […]

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Anticoagulant Therapy

May 16 2012

george

Dabigatran and the iSTAT

From “SwimRose:” Hi George, We recently had a case in our ER of a stroke patient on Pradaxa giving an INR of 2.0 with ISTAT, but the main lab instrument, an IL ACL, gave 1.1. Please comment. Hello, and thank you for your question, which drove me to an early-morning search of theAbbott Diagnostics site for […]

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Anticoagulant Therapy

May 11 2012

george

Ecarin Clotting Time: Dr. Zuckerman

On April 29, Crystal Azavedo asked about laboratories that monitor dabigatran with the ecarin clotting time (ECT). Last week at the Thrombosis and Hemostasis Summit of North America I became reacquainted with long-time colleague, Dr. Leon Zuckerman, founder of Coagulation Consultants of Des Plaines, Illinois. Coagulation Consultants is a full-service hemostasis reference laboratory that also offers the ECT. It was good to see Dr. […]

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Anticoagulant Therapy

May 7 2012

george

Reprise: Validating POC INRs

Back to our April 24 anticoagulation clinic manager’s question about when to validate a prolonged point of care (POC) prothrombin time with international normalized ratio (PT/INR). George spoke with representatives of Roche Diagnostics, distributor of Coag-U-Chek instruments, while attending the May 3–5 Thrombosis and Hemostasis Summit of North America meeting in Chicago. While Roche contends this is a local decision and […]

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Anticoagulant Therapy