George has been communicating with Drs. Elaine Keohane (Rutgers) and Larry Smith (Abbott) about how long to wait after a thrombotic event to collect a specimen for a thrombosis risk profile.
Posts - Anticoagulant Therapy
Nov 2, 2017 11:41am
Oct 13, 2017 12:56pm
Another important issue addressed by Dr. James Quesenberry, St. Luke's Laboratory, Sioux City, Iowa. His message: I understood from early on that antithrombin (AT , antithrombin III, ATIII ) deficient patients can't be assayed for unfractionated heparin using the Stago chromogenic anti-Xa heparin assay. I thought this was an all-or-none issue, only a big deal in congenital severe AT deficient folks. Today I learned that clients need to locally establish the AT level below which they believe the assay in their hands at their locale to be not accurate. This seems highly impractical to do, particularly in the non-university small to medium sized community hospital setting. We were mainly curious as to how other Stago users deal with this.
Oct 4, 2017 9:58pm
George met James T. Quesenberry, MD, FCAP, Medical Director, St. Luke's Laboratory, UnityPoint Health at the Mayo Medical Laboratories Bleeding and Thrombosing Diseases conference, Rochester, MN, September 13–15, 2017. Dr. Quesenberry subsequently addressed the issue of the ant- Xa vs PTT in monitoring heparin therapy. His message, "Our protocol for unfractionated heparin dosing uses the anti-Xa as the standard lab measurement for dose adjustments. We use Stago instrumentation with a hybrid curve. To my knowledge this has worked out well generally. We have had occasional patients, older patients with prior normal PT/PTTs who are therapeutic as far as anti-Xa level goes but then someone orders a PTT and they are high. In today's instance both the Xa and PTT were redrawn and they do repeat. Our QC and proficiencies with the Stagos are fine reportedly. Any advice? Thank you."