Feb 13 2013

george

More on PT Validation and AMR

Here’s an additional note confirming Denise Solieau’s February 12 discussion of PT validation and analytical measurable ranges (AMRs). Page 83 of the July 31, 2012 CAP survey references the value of AMRs in coagulation testing and includes this statement, “The new checklist requirements (meaning AMR) apply to hemostasis test methods that are calibrated and directly measure the concentration or […]

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Feb 12 2013

george

Validating the PT: AMR and CRR?

From Denise Soileau, Helena Laboratories: It is my understanding that calibration verification is not required for prothrombin time. Is AMR and CRR? If so how do you suggest this be accomplished? Hello, Denise, and thank you for your question. I’ve had some help from Larry Brace PhD, Edward Hospital, and Dave McGlasson MS, MLS, Wilford Hall USAF Hospital. It is true […]

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Jan 31 2013

george

Bleeding After CABG: Heparin?

Here is a puzzling case sent by Crystal Azevedo: Hi George! I have a question for you from one of my pathologists. 24 hours after an uneventful coronary bypass procedure a 51 kg patient developed acute hemorrhage. A post-protamine thromboelastogram (TEG) on the day of surgery was completely normal. At the time bleeding occurred, the patient […]

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Jan 16 2013

george

Reprise: What About PT Owren?

Reposted from November 28, 2011 from Robert Löfvenmark, MediRox AB, Nyköping, Sweden: Hello, I am from Sweden and I am curious on the international differences in use of PT. Two PT methods are predominantly used today: PT Quick, developed by Dr Armand Quick, 1935; and PT Owren, by Dr Paul Owren 1951. Most parts of the […]

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Jan 12 2013

george

PTT >180 seconds

From Renee Nutting: Is a PTT of >180 seconds always the result of heparin contamination or would such a result ever be medically desirable for a patient? Hello, Renee, and thank you for your question. A partial thromboplastin time (PTT) of >180 seconds, or one at the limit of instrument measurement, is likely an indication of […]

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Jan 12 2013

george

Reprise: Switching to Anti-Xa

Reviewing Sue Bergs‘ March 23, 2012 post asking, How Many Use the Anti-Xa?, I noticed the comment appended by “Istano” asking for data on switching from PTT to anti-Xa heparin assay for routine heparin monitoring. My answer was somewhat incomplete, so I thought I should connect this question with Marisa Marques, MD‘s June 20, 2012 question, Do You Use […]

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Jan 10 2013

george

Correction to December 6 Post

A note from my friend and colleague, John Landis, who retired from the Clinical Laboratory Science faculty at Ferris State University in Big Rapids, Michigan a few years ago: “I just read the new Cheat Sheet and saw the question from Scott Millerand your response. Scott is a graduate of my Ferris State program, but he works at St Mary’s of Saginaw not Grand Rapids. […]

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Anticoagulant Therapy

Dec 29 2012

george

Apixaban Cleared for Afib

After a lengthy delay, the US Food and Drug Administration (FDA) cleared apixaban (Eliquis®, Bristol-Myers Squibb/Pfizer) for prevention of stroke in non-valvular atrial fibrillation on 12.28.12. Apixaban is an oral direct anti-Xa anticoagulant and joins rivaroxaban and dabigatran (a direct thrombin inhibitor) as the third new oral anticoagulant cleared since 2009. Details appear in TheHeart.org.

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Dec 24 2012

george

Dabigatran Contraindicated for Heart Valves

On 12.20.12, the US Food and Drug Administration warned that dabigatran should not be used to prevent stroke in patients with mechanical heart valves. The FDA’s announcement was preceded by a Boehringer Ingelheim press release detailing the contraindication. Here is Boehringer’s new statement: “The safety and efficacy of PRADAXA in patients with bileaflet mechanical prosthetic heart valves (recently implanted […]

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Dec 24 2012

george

Extended Apixaban Therapy Reduces Recurrent DVT

According the results of a randomized control trial involving almost 2500 patients reported in the New England Journal of Medicine, twelve months of treatment with apixaban (Eliquis, Bristol-Myers Squibb/Pfizer) at either of two dosages, given after six to 12 months of anticoagulation to treat venous thromboembolism (VTE), significantly lowered the risk of recurrent VTE compared with placebo. […]

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