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QQ: Pre-op Screens

A summary of our May, 2013 Quick Question with 57 respondents:

Surgeons typically order pre-operative hemostasis screens. What assays are included in your pre-operative screen?

a. PLT count, PT, PTT: 40 (69%)
b. None, we don’t perform pre-op screen: 8 (14%)
c. PLT count, PT, PTT, TT, fibrinogen: 5 (9%)
d. PLT count, PT, PTT, BT: 3 (5%)
e. PLT count, PT, PTT, TT: 1 (3%)

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Measuring Dabi and Riva

From Kim Kinney at IU Health (formerly Clarian): Our coag lab is being asked by our heme/onc docs to have an assay for both Rivaroxaban and Dabigatran. I thought maybe you could poll your readers to see who is doing what type of assay if any! As always, thanks for your help.

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Prolonged PTT in FXII Deficiency

From Maria Grana, Baptist Health Center:

Hello, we recently had a patient with very high partial thromboplastin time (aPTT, PTT) resu;ts, anywhere from 115 to >200 seconds. The mixing study indicated a factor deficiency. Factor assays performed (IX, XI) were within normal limits, FVIII was elevated (>200) and Factor XII was 48%. It did not appear that FXII was low enough to warrant such a high aPTT. Is this a true statement? How low does the factor XII have to be to produce such a high aPTT? Thanks!

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Hemostasis Specimen Management

I am trying to find a chart or article that tells how long plasma is good for hemostasis testing. The question has arisen about fresh samples and frozen samples. We often get requests for add-on tests and need to know how long is too long. Do you know of a resource that will provide this information? Thanks, Deborah Whetzel MT(ASCP), CLS Supervisor, Children’s Hospital of the King’s Daughters.

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Recommended DIC Profile

From Julia Witt:

In an effort to standardize our healthcare organizations, we are looking at our current disseminated intravascular coagulation (DIC) panel. All sites have different ideas. George, what are your suggestions?

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Anti Phospholipid Antibody Result Interpretation

From Charles Nakar, Indiana Hemophilia and Thrombosis Center: I would like your opinion on the laboratory results below regarding a patient who recently switched providers with a history of deep venous thrombosis due to May-Thurner syndrome and possible antiphospholipid antibody syndrome. He had positive anticardiolipin antibody (ACL) screens and a positive STA-clot (x1) during the acute event and recovery but full and separated quantitative ACLs were negative.

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ARISTOTLE Analysis: Apixaban Superior to Warfarin

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

POCT ACT and Anti-Xa for ECMO

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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