Anticoagulant Therapy

Switching from DOAC to UFH

From Maureen Tacke, Program Manager, Lab, Hematology/Coagulation, St. Luke’s Health System: Our institution is working towards a conversion to Anti-Xa monitoring for patients on UFH, however, our pharmacy group has a question. What are other facilities doing if a patient presents, needs UFH, and is already on a DOAC (the baseline anti-Xa or PTT is […]

Anticoagulant Therapy

Quick Question: PT substitute

Our November, 2019 Quick Question asks, “What may you substitute for the PT when LAC prolongs the PT?” This question addresses the unreliability of the PT for monitoring Coumadin therapy when lupus anticoagulant interferes by prolonging the result. It is also relevant to PT prolongation by fibrinogen deficiency or factors II, V, VII, or X […]

Anticoagulant Therapy

AUGUSTUS Trial: Apixaban and Clopidogrel

Click or tap here to learn the results of the AUGUSTUS trial, which shows that the combination of apixaban and a P2Y12 inhibitor such as clopidogrel is safer than Coumadin and clopidogrel, Coumadin and aspirin, or apixaban and aspirin for post-PCI or acute coronary syndrome therapy.

Anticoagulant Therapy

August, 2019 QQ: DOAC Bridging

Our August, 2019 Quick Question, suggested by frequent contributor, Dave McGlasson, demonstrated the variability in clinical antithrombotic therapy bridging policies when a patient requires a procedure. Here is the question and answers provided by 70 participants: A 60-YO man taking 20 mg/day rivaroxaban for AFIB needs a high bleeding risk surgery. His creatinine is 0.9 […]

Anticoagulant Therapy

Anticoagulation After Valve Replacement

According to an August 28, 2019 Medscape post, according to pooled PARTNER 2 results, early anticoagulation was independently associated with fewer strokes after surgical valve replacement (hazard ratio, 0.17; P = .006) but with more minor bleeding after transcatheter valve replacement (HR, 1.72; P = .01). Click or tap here for the Medscape post.

Anticoagulant Therapy

July 2019 CAP DOACs Article

The July, 2019 issue of CAP Today offers an article describing hemostasis testing for patients on DOACs by Dr. Dorothy M. Adcock, Chief Medical Officer and Senior Vice President, LabCorp. Tap or click here for “What is the Impact of Direct Oral Anticoagulants?”

Anticoagulant Therapy

Vitamin K Kinetics

George received a series of questions about vitamin K kinetics from colleague and friend Catherine N. Otto, MLS, PhD, Rutgers University. Dr. Otto is assisting a Nutrition Science colleague. It seems that vitamin K deficiency (as defined by PT/INR) does not show up until there is serious depletion in the amounts of these activated proteins. Why? […]

Anticoagulant Therapy

FVL and AC Therapy

From friend, colleague, and frequent contributor Dave McGlasson: A friend contacted me about if her should be put on an anticoagulant. He is a 71 year old male who in 2004 suffered a DVT. A subsequent work-up revealed he possessed a heterozygous factor V Leiden mutation. At the time of the clot he had been […]

Anticoagulant Therapy

Rivaroxaban in CHF

On Wednesday, June 5, The Heart.org posted this entry, “Rivaroxaban Cuts Stroke Risk in Sinus-Rhythm Heart Failure: COMMANDER-HF.” (Click or Tap). This is the first publication that implicates an advantage for DOAC therapy in addition to antiplatelet therapy in preventing ischemic strokes and transient ischemic attacks in patients with congestive heart failure with. The key […]

Anticoagulant Therapy

FVIII and FIX Activity Survey

We hope that you’ve taken the opportunity to respond to our specimen integrity survey, which remains open for a few more days. We now offer a second survey developed by Precision BioLogic Inc., asking about new approaches to monitoring our many new formulations of factor VIII and factor IX concentrate. This has become a consuming issue […]

Anticoagulant Therapy

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George Fritsma is a medical laboratory scientist, educator, and author. George holds faculty appointments with Rutgers University and Michigan State University, and is a member of the International Society on Thrombosis and Hemostasis, American Association of Clinical Chemists, and American Society for Clinical Laboratory Science.

Cheat Sheets from George

Quick Question