My friend and colleague Bernadette (Bunny) Rodak of Indiana University, and chief editor of the Rodak hematology text, sent this question.

Do alcohol or cranberry products tend to increase or decrease your protime? If either raises the INR, why can't alcohol or cranberries be used to control protimes instead of taking warfarin?

I received this question from Vicki Cardone, hematology supervisor at our own Children's Hospital of Alabama, Birmingham, AL.

"Is the anti-Xa used to monitor both unfractionated heparin (UFH) and low molecular weight heparin (LMWH)? Are they the same thing?"

Hi, Vicki; good to hear from you. You can use the chromogenic anti-Xa heparin assay to monitor UFH, LMWH, and the synthetic pentasaccharide Fondaparinux (Arixtra). Although many of us maintain a separate standard curve for UFH and LMWH, researcher Dave McGlasson showed that one curve can be used for both. He calls this the "hybrid" curve. You must use a separate curve for Fondaparinux, however.

Mr. McGlasson modified Stago's heparin standard set, but Aniara has a hybrid standard curve set that requires no modification. Aniara also provides a Fondaparinux curve.

I had promised to report some of the information we gained attending the Society for Angiography and Interventions and American College of Cardiology annual meeting held in Chicago March 29-April 1. I was particularly struck by the number of clinical trials reporting the efficacy and safety figures for bivalirudin (Angiomax) such as ISAR-REACT 3 and HORIZONS AMI..

This question comes from the American Society for Clinical Laboratory Science Consumer Information Forum and was forwarded to Fritsma Factor by Prof. Bernadette (Bunny) Rodak of Indiana University. It is modified to mask the identity of the inquirer.

“I have been on 5 mg/day of Coumadin for three months following hip replacement surgery and my INR is stable and therapeutic. My doctor says I should limit myself to two alcoholic beverages a day but that I should have those two every day. I do not like to have a drink every day and my question is,  "What harm can come if I do not drink for a week or two and then have four or five in one evening?”

David Garcia, MD, president of Anticoagulation Forum reports the US Centers for Medicare and Medicaid Services (CMS) has drafted a decision to generalize patient home Warfarin monitoring. In-home PT/INR testing reimbursement has been confined to patients with mechanical heart valves. Pending a final ruling this fall, reimbursement will be extended to self-monitoring of Warfarin for atrial fibrillation and deep venous thrombosis.

I'm attending the American College of Cardiology annual meeting in Chicago today and tomorrow. There is a lot of attention being paid to new antithrombotics beyond rivaroxiban and dabigatran. There are at least 10 new anti-Xa and 5 new direct thrombin inhibitor antithrombotics in clinical trials. I'll provide new information on this subject when I return home on Thursday, April 3. Geo.

Hi George:

I am lead heme tech at a medium sized hospital.  My boss asked me why we sent out a thrombin time on a patient on heparin.  There's all sorts of ways to answer it. I wonder what you suggest. Do I call the ordering physician and ask him why he'd want to run this? Or am I just forgetting the clinical usefulness of running a thrombin time while the patient is on heparin? Your ideas will be greatly appreciated.

Kathy Wagner

A report appeared on HeartWire yesterday identifying the cause for the recent series of reactions to heparin contamination as oversulfated chondrotin sulfate. Follow this linkto the story.

There is an interesting article in the February issue of the Journal of Thrombosis and Haemostasis, Trippodi A, Chantarangkul V, Mannucci PM. The international normalized ratio to prioritize patients for liver transplantation: problems and possible solutions. J Thrombos haemostas 2008;6:243-8. I'm led to provide a clinical discussion of reporting conventions for the prothrombin time test in seconds and INR.

We also try to confuse clinicians with our use of II, V, and X as Sue Osier mentioned. If you see an order for factor X, chances are the clinician wanted an anti-Xa heparin assay, although some institutions are using a chromogenic factor X as a PT substitute when the PT is not reliable.

Likewise, an isolated order for factor V or factor II most likely mean factor V Leiden mutation and factor II (prothrombin) 20210 mutation, repectively.