A May 7, 2013 report from the ARISTOTLE trial was highlighted on The Heart.Org and showed superior efficacy for apixaban versus warfarin in stroke, systemic embolism, and all-cause death.
The Heart.org also provided this nicely illustrated and definitive European Heart Rhythm Association guide to the use of the new oral anticoagulants, including edoxaban, the most recent direct anti-Xa inhibitor under late-stage development by Daiichi Sankyo.
Europace 2013
From Deanna Miller, Point of Care Testing (POCT) Coordinator at Children’s of Alabama:
We have recently merged our extracorporeal membrane oxidation (ECMO) team with the cardiovascular team from the University of Alabama at Birmingham (UAB) and we are doing all pediatric cardiovascular cases at Children’s now. We would like some insight into monitoring coagulation using the activated coagulation time (ACT) and the chromogenic anti-Xa heparin assay.
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From Scott Cornelius at Johnson & Johnson, I am interested in finding out if you have any samples of what good bleeding protocols for large teaching hospitals are like. With all of the new oral agents on the market there surely are many new challenges in managing patients with ICH and other serious bleeding complications. Thanks for your insight.
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A message from Patti Richardson and Dr. Manjula Balasubramanian, St Christopher’s Hospital for Children, Philadelphia, PA (originally posted November, 2011):
Is it necessary to have a reference range for the international normalized ratio (INR)? It is a calculated value. If so, should these be derived from the normal prothrombin time (PT) ranges? The Heme CAP checklist does not address this question but the Gen CAP requirement is for all reported values to have reference ranges. Thanks for your help.
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From Elizabeth Kreuser:
Our pharmacy is using a point of care (POC) device to monitor prothrombin times with international normalized ratios (INRs). However, they have a patient with an anti-phospholipid antibody (APA). We did a quick study using Stago Neoplastin Cl Plus, Stago clotting factor II, and the POC device. Results were:
Assay Test 1 Test 2
Factor II clotting assay 17% 14%
POC INR 3.5 4.5
Stago Neoplastin Cl Plus INR 2.6 2.8
They are satisfied with the correlation and are going to continue with POC keeping the patient between 2–3, because they feel this will correlate with a 24–45% factor II activity, which is what they want to achieve. I have been trying to find some references and not coming up with much. I think that the numbers are off. Any advice?
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A message from Crystal Azevedo, Eastern Maine Medical Center:
Hello George, I have a question regarding the new Xa inhibitors and dabigatran and point of care (POC) systems. Is there any known interference in the prothrombin time/international normalized ratio (PT/INR) determination of POC assays when a patient is on one of these medications? We are using the iSTAT system on our ED patients and we see the population on these medications growing rapidly. Thanks!
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George substituted for Dave McGlasson and presented, “Monitoring the New Antithrombotics: Whatever Happened to the PT and PTT?“ on Wednesday, April 3, 10 AM; and “Antiplatelet Therapy, Do Aspirin and Plavix Work?” on Thursday, April 3, 2:30–2:30 PM at the Great Plains Regional Laboratory Expo in Omaha Nebraska. His presentation handouts, in PDF, appear on our Audio Modules page. Thanks to all who participated in these presentations, and please feel free to post any follow-up questions or comments to George through this web site.
From Linda Stang, Alberta Health Services: As apixaban (Eliquis) is sure to start wreaking havoc in some of our special coag assays (read: tests will be ordered while patients are on this drug, but they WON’T tell us…), I did a search for publications about apixaban interference, and found nothing. Does anyone have any experience with interference in lupus anticoagulant panels (DRVVT- or SCT-based) or any other tests such as clot-based protein C or S assays, activated protein C resistance clot based assays, etc.?
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Anticoagulant Therapy | George Fritsma | 
May 9, 2013 5:25 am | 
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