Dec 2 2012

george

Monitoring Coumadin When Bridging from LMWH or a DTI

This is a message first posted on November 8, 2012 from Dave Easler, who originally sent his question to Dave McGlasson, Wilford Hall USAF Hospital, San Antonio. Both Daves gave me permission to post it here. It was a pleasure to listen to your presentation at the 2012 Northeast Laboratory Conference in Portland, Maine last month. I have been […]

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Anticoagulant Therapy

Oct 25 2012

george

QQ Summary: Heparin Monitoring History

Results of our September, 2012 Quick Question: Historically, what assay was used to monitor heparin? a. Bleeding time: 14 (17%) b. Recalcification time: 7 (9%) c. Lee-White clotting time: 51 (63%) d. Thromboplastin generation time: 9 (11%) Participants need to be well-read, or “of a certain age” to answer this one. Bleeding time is incorrect. […]

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Oct 15 2012

george

Quest Presentation

Thank you to all who attended George’s presentation, Case Studies in Antithrombotic Therapy, made on Friday, October 12 at the Quest Diagnostics Case-oriented Symposium on Bleeding and Thrombosis in Crystal City, VA, near Washington, DC. As promised, here is my presentation in 6-per-page handout format. Please click the link and feel free to download the file. […]

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Anticoagulant Therapy

Oct 12 2012

george

PEG-ylated Drugs and Clotting Assays

From Vanessa Chan, Sick Kids Hospital in Toronto: Hi George,  Do you have any information on how PEG-ylated drugs (PEG-ylated to increase the half life of the drugs) may affect clotting assays? Thanks! Vanessa. Hi, Vanessa, While I have heard that polyethylene glycol (PEG) in drugs can affect the phospholipid structures in prothrombin time (PT) thromboplastin reagent and […]

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Anticoagulant Therapy

Sep 12 2012

george

Validating High POC INR Results

Our April 24, 2012 post (and Quick Question), POC: When to Validate a High INR has attracted a provocative comment from Alan Neal of New Zealand. I’ve added this link so the comment does not get buried and to attract additional discussion from our participants.

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Anticoagulant Therapy

Sep 12 2012

george

Validating High POC INR Results

Our April 24, 2012 post (and Quick Question), POC: When to Validate a High INR has attracted a provocative comment from Alan Neal of New Zealand. I’ve added this link so the comment does not get buried and to attract additional discussion from our participants.

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Anticoagulant Therapy

Sep 12 2012

george

Hybrid Curve Controls for Anti-Xa Heparin Assay

This is from frequent contributor Crystal Azevedo, Eastern Maine Healthcare Systems. Hi George, Look forward to seeing you next month in Portland, Maine! I am setting up a hybrid curve for heparin monitoring using the Rotachrom Heparin reagent and Stago’s hybrid calibrator. Which control material should be used with this curve? Thanks! Hi, Crystal, I look forward […]

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Anticoagulant Therapy

Sep 7 2012

george

Dabigatran Gene Variant

Here’s a new outcome from the Dabigatran etexilate RE-LY study that suggests there is a gene variant in 1/3 of Caucasians that converts less of the prodrug, reducing the risk of bleeding without reducing efficacy.

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Anticoagulant Therapy

Aug 28 2012

george

PT/INR Results Using ISI 1.0 Reagents

From Terezinha Paz Munhoz: we started to use recombinant thromboplastin,RecombiPlasTin 2G (ISI 1.0) on our IL ACL TOP 500. The PT results are quite different from rabbit brain reagent. The high sensitivity shows a wide range: 8–220 seconds. We know the method linearity in this equipment is 8,0–320 seconds, and the percentage activity (that we still report) is “crazy” […]

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Anticoagulant Therapy

Aug 25 2012

george

How Rapidly Does INR Decrease?

Here is a question that came to me from the American Society for Clinical Laboratory Science Consumer Web Forum: How quickly will an elevated international normalized ratio (INR, PT/INR) decrease/time? I appreciate the answer may be “it depends,” but for patients on warfarin and with an elevated INR (for example 4.0 in a patient with and INR […]

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Anticoagulant Therapy