- International Council for Standardization in Haematology Recommendations for Hemostasis Critical Values, Tests, and Reporting. [Journal Article]Semin Thromb Hemost 2019ST
- This guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH), the aim of which is to provide hemostasis-related guidance documents for clinical laboratories. The current ICSH document was developed by an ad hoc committee, comprising an international collection of both clinical and laboratory experts. The purpose of this ICSH document is to p…
This guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH), the aim of which is to provide hemostasis-related guidance documents for clinical laboratories. The current ICSH document was developed by an ad hoc committee, comprising an international collection of both clinical and laboratory experts. The purpose of this ICSH document is to provide laboratory guidance for (1) identifying hemostasis (coagulation) tests that have potential patient risk based on analysis, test result, and patient presentations, (2) critical result thresholds, (3) acceptable reporting and documenting mechanisms, and (4) developing laboratory policies. The basis for these recommendations was derived from published data, expert opinion, and good laboratory practice. The committee realizes that regional and local regulations, institutional stakeholders (e.g., physicians, laboratory personnel, hospital managers), and patient types (e.g., adults, pediatric, surgical, etc.) will be additional confounders for a given laboratory in generating a critical test list, critical value thresholds, and policy. Nevertheless, we expect this guidance document will be helpful as a framework for local practice.
- Reduced dose of rivaroxaban and dabigatran vs. vitamin K antagonists in very elderly patients with atrial fibrillation in a nationwide cohort study. [Journal Article]Europace 2019E
- CONCLUSIONS: This study shows for the first time in more than 25 000 new real-life anticoagulant users for AF aged ≥85 years a neutral overall benefit-risk of rivaroxaban 15 mg vs. VKA and a favourable overall benefit-risk of dabigatran 110 mg vs. VKA on relevant clinical events.
- Antithrombotic prescriptions for many general surgery patients significantly increases the likelihood of post-operative bleeding complications. [Journal Article]Am J Surg 2019AJ
- CONCLUSIONS: The data should remind surgeons to closely monitor the peri-operative management and post-operative course of patients pre-operatively prescribed antithrombotics-especially enoxaparin and rivaroxaban given the high risk of postoperative bleeding complications.
- Factor Xa inhibitors for preventing recurrent thrombosis in patients with antiphospholipid syndrome: a longitudinal cohort study. [Journal Article]Lupus 2019; :961203319881200L
- CONCLUSIONS: Factor Xa inhibitors may not be recommended for antiphospholipid syndrome.
- Direct Oral Anticoagulant Use Following Transcatheter Aortic Valve Replacement: A Case Series. [Journal Article]J Cardiovasc Pharmacol 2019JC
- CONCLUSIONS: DOAC therapy after TAVR was generally safe and well tolerated. Taken in context of other retrospective studies this data suggests that the presence of valvular heart disease, specifically TAVR in this case, should not preclude the use of DOACs.
- Differences In Gastrointestinal Safety Profiles Among Novel Oral Anticoagulants: Evidence From A Network Meta-Analysis. [Journal Article]Clin Epidemiol 2019; 11:911-921CE
- CONCLUSIONS: The risk of GI bleeding significantly varies among different NOAC regimens, and evidence shows that apixaban and edoxaban had the most favorable MGI bleeding safety profile, while rivaroxaban and dabigatran etexilate were the least safe.
- Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK. [Journal Article]BMJ Open 2019; 9(10):e031342BO
- CONCLUSIONS: While the majority of patients with NVAF in the UK initiating NOAC treatment received continuous therapy in the first year of treatment, a substantial proportion of patients experienced gaps in treatment leaving them less protected against thromboembolism during these periods.
- Altered fibrin clot properties and fibrinolysis in patients with atrial fibrillation: practical implications. [Journal Article]Europace 2019E
- Compelling evidence indicates that a hypercoagulable state occurs in patients with atrial fibrillation (AF) including those in sinus rhythm following paroxysmal and persistent AF. Activation of blood coagulation in AF reflects heightened thrombin generation with the subsequent increased formation of fibrin as evidenced by elevated soluble fibrin monomers and D-dimer. Formation of denser fibrin me…
Compelling evidence indicates that a hypercoagulable state occurs in patients with atrial fibrillation (AF) including those in sinus rhythm following paroxysmal and persistent AF. Activation of blood coagulation in AF reflects heightened thrombin generation with the subsequent increased formation of fibrin as evidenced by elevated soluble fibrin monomers and D-dimer. Formation of denser fibrin meshworks, relatively resistant to plasmin-mediated lysis has been demonstrated in patients with AF. The presence of stroke risk factors in AF, such as diabetes, heart failure, hypertension, previous myocardial infarction, or stroke, advanced age have been shown to be linked to the prothrombotic clot characteristics, including reduced clot permeability and lysability. Importantly, biomarkers, including cardiac troponins and N-terminal pro-brain natriuretic peptide, are associated with thrombin generation and fibrin-related markers in AF patients. Recently, increased fibrin clot density (low clot permeability measured in plasma-based assays) and impaired fibrinolysis measured off anticoagulation have been demonstrated to predict ischaemic cerebrovascular events in patients with AF receiving vitamin K antagonists and those on rivaroxaban. The current review summarizes evidence for a role of altered fibrin clot properties and hypofibrinolysis in AF and their prognostic value in terms of adverse events.
- Ruling out lupus anticoagulants with mixing test-specific cutoff assessment and the index of circulating anticoagulant. [Journal Article]Res Pract Thromb Haemost 2019; 3(4):695-703RP
- CONCLUSIONS: The data indicate that MTC has a tendency to generate not-corrected mixing tests in factor-deficient, warfarin, and other inhibitor samples, while ICA exhibited higher specificity. When we perform the mixing test and interpret the data, it is important to understand the characteristics of the indexes for maximizing the diagnostic potential of mixing test.
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- Direct oral anticoagulants and warfarin for venous thromboembolism treatment: Trends from 2012 to 2017. [Journal Article]Res Pract Thromb Haemost 2019; 3(4):668-673RP
- CONCLUSIONS: Rivaroxaban and apixaban use to treat VTE has increased dramatically since receiving FDA approval, whereas warfarin use has plummeted. Dabigatran and edoxaban are infrequently prescribed. Given widespread usage of rivaroxaban and apixaban, there is a need for continued monitoring of the comparative effectiveness of these OAC therapies in real-world settings.