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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Anticoagulant Therapy

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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Anticoagulant Therapy

Dec 23 2012

george

Rivaroxaban Equivalent to Enoxaparin for DVT & PE

Here is a link to the latest EINSTEIN findings comparing rivaroxaban with enoxaparin for treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) reportedDr. Harry Buller at the American Society for Hematology meeting on 12.11.12 in Atlanta, Georgia.

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Anticoagulant Therapy

Dec 7 2012

george

FDA Requires Precise Heparin Label

Elaine Benoit, Precision BioLogic, sent an FDA alert regarding a heparin label change. “This label change will require manufacturers of Heparin Lock Flush Solution, USP and Heparin Sodium Injection, USP to clearly state the strength of the entire container of the medication followed by how much of the medication is in 1 milliliter (mL). These modifications […]

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Anticoagulant Therapy

Dec 6 2012

george

Anti-Xa Calibrators

This post comes from Scott Miller, St. Mary’s of Michigan: We will soon be validating our activated partial thromboplastin time (APTT, PTT) heparin therapeutic range by using a comparison between an anti-Xa assay and APTTs run with our new lot of APTT reagent. I have always understood that when calibrating an anti-Xa assay for this procedure, one […]

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Anticoagulant Therapy

Dec 4 2012

george

Summary of Anticoagulant Therapy Guidelines

Shirlyn McKenzie, PhD, University of Texas Health Science Center at San Antonio, and I developed the following summary for the clinical applications of anticoagulant therapy. Dr. McKenzie will use this for a PA lecture. Please review and offer your suggestions, corrections, or updates. Percutaneous intervention (PCI, cardiac catheterization): use IV anti-glycoprotein IIb/IIIa agent during procedure such […]

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Anticoagulant Therapy

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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Anticoagulant Therapy

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