Precision BioLogic Inc., the folks who sponsor the Fritsma Factor, hosted a June 19-20 roundtable at their beautiful new facility in Dartmouth, Nova Scotia, across the harbor from Halifax. Participants were Dorothy (Dot) Adcock-Funk, MD, Medical and Laboratory Director of Esoterix Coagulation in Englewood, CO; Kandice Kottke-Marchant, MD, PhD, Chair of the Department of Pathology and Section Head of Thrombosis and Hemostasis, Cleveland Clinic; Marisa B. Marques, MD, Medical Director of Special Coagulation and Transfusion Medicine, University of Alabama Hospital, Birmingham, AL (UAB); and John D. Olson, MD, PhD, Director of Clinical Laboratories, University of Texas Health Science Center, San Antonio, TX.
Dr. Adcock discussed means for laboratory monitoring of current intravenous direct thrombin inhibitors Argatroban, Lepirudin, and Bivalirudin; and also the new oral thrombin inhibitor, Dabigatran, currently in trials. She also discussed monitoring the experimental oral anti-Xa drugs Rivaroxaban and Apixaban currently under FDA review.
Dr. Marchant described several whole blood, optical aggregometry, and urine-based assays designed to detect and monitor aspirin and Clopidogrel resistance. She linked laboratory-determined resistance results with antiplatelet resistance failure and the risk of recurrent advers events.
Dr. Marques reviewed data collected at UAB describing the weak clinical efficacy of tests for heparin-induced thrombocytopenia with thrombosis (HIT), including the reference serotonin release assay, and various ELISA methods.
Dr. Olson reviewed CAP survey-generated data that reveals laboratory weaknesses in quantitative D-Dimer assay reporting and how their variability affects the diagnosis of venous thromboembolism.
The participants’ presentations were concise and revealing, and were followed by technical and clinical insights shared by the discussants. Parts of the discussion was directed towards the “blue ocean” approach, a search for creative new ways to accomplish the clinical goals for the laboratory management of hemostasis.
We’ll be posting reviews of each of the four discussions here as guest blogs in the next three weeks. Be on the lookout for additions to the guest blog column. Geo