Category: Anticoagulant Therapy
From Prof. Jeanne Isabel, Northern Illihois University, a long-time friend and colleague. Hi George, a colleague who works at a cancer center has a patient on hydrocortisone (not sure how much) and her prothrombin time and international normalized ratio (PT/INR) were elevated to 54 s/4.9. she is on Coumadin and last time her INR was in the therapeutic range. She did not have symptoms to correlate with the elevated results. would the hydrocortisone cause this? Thanks.
From Karen Dallas, MD, Saskatoon Health Region: I have searched the internet and cannot find a direct connection between thromboembolism prophylaxis with direct thrombin inhibitors and the induction of a prothrombotic state once discontinued. We have observed a few cases which seem to exhibit this phenomenon at my institution. Can you guide me towards any information on this occurrence?
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The FDA advisory committee yesterday, January 16, 2013, unanimously withheld clearance for rivaroxaban’s acute coronary syndrome indication. Details appear in today’s Medscape Oncology Heartwire headline. This is the third time that Janssen’s application has been denied for this indication. Rivaroxaban is cleared for stroke prevention in atrial fibrillation, thrombosis prevention following total hip or knee replacement surgery, and treatment following venous thromboembolism.
Announcement provided by Ali Sadeghi-Khomami, PhD; Research and Development Manager, Precision BioLogic Inc:
In documents released ahead of an FDA advisory panel meeting on January 16, agency staff on Tuesday expressed skepticism that the data submitted by Johnson & Johnson demonstrate that Xarelto (rivaroxaban) is effective for treating acute coronary syndrome (ACS) in patients with a previous history of heart attack. The drug-maker’s current submission seeks clearance of the therapy for treating acute coronary syndrome for 90 days.
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From our frequent contributor Crystal Azevedo, Eastern Maine Health System: Hello George, I am working up more patients taking the new directed oral anticoagulants (NOACs) for therapy. Is there a relationship between rivaroxaban and an elevated plasma homocysteine level? I have seen this more than once and I’m curious. Thanks!
A quick note from Madan Verma: “Is there any thing such as a “vitamin agonist” and does it some how mimic factor VII deficiency? All these years I’ve read about vitamin K antagonists (VKA) but not agonists. I came across this word while reviewing a factor VII assay done by a reference lab.”
- 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.