- At what INR would they repeat the point of care (POC) prothrombin time and international normalized ratio (PT/INR)?
- At what INR would they do a central laboratory (plasma-based) INR to confirm the POC INR?
- Regarding the correlation between CoaguChek INR and central lab (plasma-based) INR how much does the reagent source of lab INR affect the results. Roche use a recombinant thromboplastin.
Category: Anticoagulant Therapy
The Heart.org is now part of Medscape. Here’s a December 5, 2013 announcement: ‘New’ Oral Anticoagulant Stroke-Protection Benefits in AF Cut Across Subgroups in Meta-Analysis. This is a summary of Ruff CT, Giugliano RP, Braunwald E. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2013; DOI: 10.1016/S0140-6736(13)62343-0 that documents the relative safety and efficacy of all the new direct oral anticoagulants (DOACs). Geo
From Meg Hardin, George, The surgical services in our hospital are requesting that we look into purchasing the Thromboelastograph (TEG) or Rotational Thromboelastometry System (ROTEM) in order to decrease blood utilization. TEG representatives tell surgical services that they can receive results with in 2 minutes of the blood being placed on the analyzer. I know nothing (except what I read) about these analyzers and was wondering if any of your readers who use TEG or ROTEM could give me some information? I thank everyone in advance for their time with this question.
Prof. Jeanne Isabel, Medical Laboratory Science Program Director, Northern Illinois University, forwarded the following question, posted to the American Society for Clinical Laboratory Science Consumer Forum:
“We run prothrombin time assays with international normalized ratios (PT/INRs) on most all patients pre-procedure regardless of whether they take Coumadin or heparin. I have done some research and this is the general practice but I am wondering if there is a better test. Most of our patients are on Aspirin and/or Plavix or Lovenox rather than Coumadin or heparin. Does the PT/INR reflect the use of these medications or is there a study that would better indicate a risk for bleeding? We do activated clotting times (ACTs) in procedures with the use of heparin. Does that also reflect the anticoagulation affect of Aspirin and Plavix?”
Elaine Benoit of Precision BioLogic Inc forwarded a November 6, 2013 message recommending new spinal catheter insertion and removal times for patients receiving low molecular weight heparin (LMWH) such as enoxaparin (Lovenox or generics). To avoid spinal bleeds, the FDA now recommends discontinuing LMWH treatment and delaying procedures by 12 hours when using a prophylactic dose and 24 hours when using a therapeutic dose, 1 mg/kg twice daily or 1.5 mg/kg once daily. They further recommend waiting 4 hours after a procedure to restart therapy. Thanks, Elaine, for the heads-up!
Hi George, We have a question about performing mixing studies following fondaparinux or enoxaparin administration. How long do you recommend waiting (# half lifes) to perform mixing studies after these medications are administered? Thanks, Carla Purvis, Parkview Regional Medical Center, Fort Wayne, IN.