As you've read in the news, Baxter Healthcare Corporation, Deerfield, IL recalled nine lots of unfractionated heparin January 17 after the US CDC documented 65 probable cases of acute anaphylaxis in hemodialysis patients using the heparin, including one death. It isn't clear...

Larry Smith, PhD, of Memorial Sloan-Kettering asks if anyone has an adaptation for running the chromogenic factor X assay on the ACL-TOP.

Here is a question from Mary Rozmanc in Sunnybrook:

 

Hi, George,

 

I will be evaluating two vendor ACT devices. Is there any information you have or that you can point me to to help me set up a proper evaluation? The reference instrument will be the Medtronic ACT II. I would like to know what type of acceptance criteria I can decide on before I begin the evaluation. Both vendors use ACT cartridges.

 

Would a cath lab benefit from a high-range ACT test cartridge and when would this be the case?

 

Thank you, Mary

POCT/Projects Coordinator

Here is a question sent to Kim Kinney from a Clarian Pharm D:

 

I've got a great question and I hope you can help.  We are using more and more induced hypothermia for cardiac arrest, and will especially see this increase as our regionalization for MI program gets up to speed.  So if someone is cooled, and they go to cath lab for an intervention and the anesthetist needs to give heparin to get to a certain activated clotting time (ACT, a POC test in surgery), what do we do since the cooling affects the ACT? Further, I was told that for a PTT, we should call the lab and let them know to run it at a certain temp to match the patient. Thanks! Joanna

I received a question last Friday asking whether the activated clotting time assay (ACT) is affected by low molecular weight heparin such as Lovenox. Yes, but first...

It seems strange North American coagulation laboratories have not adopted local ISI or INR calibration despite articles such as Poller L, Keown M, Ibrahim S, et al. Comparison of local International Sensitivity Index calibration and 'direct INR' methods in correction of locally reported International Normalized Ratios: an international study. J Thromb Haemost 2007;5:1002-9 and Adcock DM, Johnston M. Evaluation of frozen plasma calibrants for enhanced standardization of the International Normalized Ratio (INR): A multi-center study. Thromb Haemost 2002; 87:74-9 that demonstrate improved local INR accuracy and lot-to-lot stability. Further...

A post from Bryan McGill, PharmD at St. Mary's Hospital in Madison, WI:

We have a patient with a history of HIT, so we are using Arixtra 2.5 mg q24h for prophylaxis.  Unfortunately the patient also has a CrCl hovering at 30mL/min, so I am worried that the drug may start to build up.  Are you aware of any guidelines for Xa monitoring for fondaparinux? Thanks for your help.

Two new oral anticoagulants are emerging from phase III trials and receiving attention at this year's American Society of Hematology annual meeting, in progress in Atlanta, GA. These are...

It seems that many North American institutions are moving more and more to the use of low molecular weight heparin...

In response to Dana Haas' question about IV Lovenox (Enoxaparin, low molecular weight heparin, LMWH) and the PTT, while it is true the PTT is relatively insensitive to LMWH, it is slightly prolonged.