scholarly journals What is the effect of rivaroxaban on routine coagulation tests?

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 334-336 ◽  
Author(s):  
Deborah M. Siegal ◽  
Barbara A. Konkle
Keyword(s):  
Emergency Department ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
International Normalized Ratio ◽  
Activated Partial Thromboplastin Time ◽  
Past Medical History ◽  
Surgical Team ◽  
Normal Range ◽  
Coagulation Tests ◽  
Routine Coagulation

Abstract A 78-year-old female presents to the emergency department with a traumatic hip fracture. Her past medical history is significant for atrial fibrillation for which she receives rivaroxaban 20 mg daily. Her dose was last taken 12 hours ago. Routine bloodwork conducted in the emergency department shows prothrombin time, international normalized ratio, and activated partial thromboplastin time within the normal range, and estimated glomerular filtration rate of 50 mL/min/1.73 m2 (normal is >90 mL/min/1.73 m2) You are asked by the surgical team to confirm that it is safe to proceed with surgery at this time using neuraxial anesthesia.

Effect of Centrifuge Temperature on Routine Coagulation Tests

2018 ◽  
Vol 139 (3) ◽  
pp. 158-163 ◽  
Author(s):  
Hayrullah Yazar ◽  
Fatma Özdemir ◽  
Elif Köse
Keyword(s):  
Partial Thromboplastin Time ◽  
International Normalized Ratio ◽  
Activated Partial Thromboplastin Time ◽  
Time Intervals ◽  
Blood Samples ◽  
Test Parameters ◽  
Coagulation Tests ◽  
Volume Blood ◽  
D Dimer ◽  
Routine Coagulation

Background: This study investigated the effects of cooled and standard centrifuges on the results of coagulation tests to examine the effects of centrifugation temperature. Methods: Equal-volume blood samples from each patient were collected at the same time intervals and subjected to standard (25°C) and cooled centrifugation (2–4°C). Subsequently, the prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer values were determined in runs with the same lot numbers in the same coagulation device using the Dia-PT R (PT and INR), Dia-PTT-liquid (aPTT), Dia-FIB (fibrinogen), and Dia-D-dimer kits, respectively. Results: The study enrolled 771 participants. The PT was significantly (p < 0.018) higher in participants on anticoagulant therapy. The respective median values of the test parameters determined using the standard and cooled centrifuges were as follows: PT 10.30 versus 10.50 s; PT (INR) 1.04 versus 1.09 s; APTT 28.90 versus 29.40 s; fibrinogen 321.5 versus 322.1 mg/dL; and D-dimer 179.5 versus 168.7 µg FEU/mL. There were significant differences (p < 0.001) in the parameters between the values obtained with the standard and cooled centrifuges. Conclusions: Centrifuge temperature can have a significant effect on the results of coagulation tests. However, broad and specific disease-based studies are needed.

scholarly journals Factor XI deficiency and delayed hemorrhages after resection of choroid plexus papilloma: illustrative case

2021 ◽  
Vol 2 (24) ◽  
Keyword(s):  
Choroid Plexus ◽  
Choroid Plexus Papilloma ◽  
Activated Partial Thromboplastin Time ◽  
Illustrative Case ◽  
Normal Range ◽  
Factor Xi ◽  
True Incidence ◽  
Factor Xi Deficiency ◽  
Measured Activity ◽  
Routine Coagulation

BACKGROUND Factor XI deficiency, also known as hemophilia C, is a rare inherited bleeding disorder that may leave routine coagulation parameters within normal range. Depending on the mutation subtype, prolonged activated partial thromboplastin time may occasionally be found. The disease has an autosomal transmission, with an estimated prevalence in the general population of approximately 1 in 1 million. Heterozygosis accounts for partial deficits, but the tendency to bleed is unrelated to the measured activity of factor XI. Diagnosis usually follows unexpected hemorrhages occurring spontaneously or after trauma or surgical procedures. OBSERVATIONS Few cases have been reported in the neurosurgical literature, all occurring spontaneously or after head trauma. Owing to its subtle features, the true incidence of the disease is probably underestimated. The authors report a case of a patient with previously undiagnosed factor XI deficiency who underwent uncomplicated resection of a fourth-ventricle papilloma and experienced delayed, severe hemorrhagic complications. LESSONS The known association between choroid plexus tumors and intracranial bleeding raised differential diagnosis issues. This report may serve to help to investigate delayed hemorrhages after cranial surgery.

scholarly journals The distribution of anti-factor Xa activity value, PT and APTT at peak and trough times in patients with direct anti-factor Xa inhibitors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Ono ◽  
K Fukushima ◽  
T Yamazaki ◽  
H Takahashi ◽  
Y Hori
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Factor Xa ◽  
International Normalized Ratio ◽  
Activated Partial Thromboplastin Time ◽  
Peak Time ◽  
Chromogenic Assay ◽  
Standard Values ◽  
Prescribing Information ◽  
Routine Coagulation

Abstract Background Although patients taking direct oral anticoagulants (DOACs) do not require routine coagulation monitoring, the distribution of anti-factor Xa activity (AXA) values, prothrombin time (PT), PT-international normalized ratio (INR) and activated partial thromboplastin time (APTT) in patients on apixaban, edoxaban and rivaroxaban therapy is still not clear. Purpose The aim is to set the standard values of AXA values, PT, PT-INR and APTT in patients using DOACs. Methods We measured AXA, using chromogenic assay with the HemosIL Liquid Heparin kit, PT, PT-INR and APTT at trough and peak times in 224 patients with non-valvular atrial fibrillation and venous thromboembolism, of whom 90 received apixaban, 100 received edoxaban and 34 received rivaroxaban. The peak time was defined as 3 hours after the intake of apixaban or rivaroxaban, and 2 hours after the intake of edoxaban. The trough time was defined as that immediately before the intake. The AXA values, PT, PT-INR and APTT were measured at least 72 hours after the start of treatment. The dosage of DOACs is defined according to the prescribing information in Japan. Results (The order of results below is apixaban, edoxaban and rivaroxaban, respectively.) The average AXA values were 2.29, 0.23 and 0.39 (IU/mL) at trough time, and 3.04, 1.01 and 1.70 (IU/mL) at peak time. The average PT values were 17.9, 12.9 and 13.1 (s) at trough time, and 19.7, 15.5 and 17.5 (s) at peak time. The average PT-INR values were 1.49, 1.07 and 1.08 at trough time, and 1.65, 1.29 and 1.45 at peak time. The average APPT values were 34.5, 31.3 and 32.0 (s) at trough time, and 39.5, 35.9 and 39.8 (s) at peak time. Conclusion Our findings reveal the standard values of AXA, PT, PT-INR and APTT in patients using apixaban, edoxaban and rivaroxaban in each dosage. The DOACs should be changed if the measured value is out of those standard values in 90% confidence interval. Funding Acknowledgement Type of funding source: None

Reducing unnecessary testing in the emergency department: The case for INR and aPTT

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 534-541
Author(s):  
Davy Tawadrous ◽  
Sarah Detombe ◽  
Drew Thompson ◽  
Melanie Columbus ◽  
Kristine Van Aarsen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Cost Savings ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Educational Module ◽  
Patients Âgés ◽  
Coagulation Testing ◽  
Aggregate Rate ◽  
Routine Coagulation

ABSTRACTObjectiveRoutine coagulation testing is rarely indicated in the emergency department. Our goal is to determine the combined effects of uncoupling routine coagulation testing (i.e., international normalized ratio [INR]; activated partial thromboplastin time [aPTT]), disseminating an educational module, and implementing a clinical decision support system (CDSS) on coagulation testing rates in two academic emergency departments.MethodsA prospective pre-post study of INR-aPTT uncoupling, educational module distribution, and CDSS implementation in two academic emergency departments. All patients ages 18 years and older undergoing evaluation and treatment during the period of August 1, 2015, to November 30, 2017, were included. Primary outcome was coagulation testing utilization during the emergency department encounter. Secondary outcomes included associated costs, frequency of downstream testing, and frequency of blood transfusions.ResultsUncoupling INR-aPTT testing combined with educational module distribution and CDSS implementation resulted in significantly decreased coupled INR-aPTT testing, with significantly increased selective INR and aPTT testing. Overall, the aggregate rate of coagulation testing declined for both INR and aPTT testing (48 tests/100 patients/day to 26 tests/100 patients/day). There was a significant decrease in associated daily costs (median cost per day: $1048.32 v. $601.68), realizing estimated annual savings of $163,023 Canadian dollars (CAD). There was no signal of increased downstream testing or patient blood product requirements.ConclusionCompared to baseline practice patterns, our multimodal initiative significantly decreased coagulation testing, with meaningful cost savings and without evidence of patient harm. Clinicians and administrators now have a growing toolkit to target the plethora of low-value tests and treatments in emergency medicine.

Coagulation Testing in Acute Ischemic Stroke Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S101-S102
Author(s):  
Y S Kamel
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Oral Anticoagulants ◽  
False Negative ◽  
International Normalized Ratio ◽  
Vitamin K Antagonist ◽  
Activated Partial Thromboplastin Time ◽  
Test Results ◽  
Coagulation Testing ◽  
Coagulation Tests

Abstract Introduction/Objective In patients who present with acute ischemic stroke while on treatment with non-vitamin K antagonist oral anticoagulants (NOACs), coagulation testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of coagulation testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. Methods Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants). Results of locally performed nonspecific (international normalized ratio, activated partial thromboplastin time, and thrombin time) and specific (antifactor Xa tests, hemoclot assay) coagulation tests were documented. The implications of test results for thrombolysis decision-making were explored. Results In the 290 patients enrolled, nonspecific coagulation tests were performed in ≥95% and specific coagulation tests in 26.9% of patients. Normal values of activated partial thromboplastin time and international normalized ratio did not reliably rule out peak drug levels at the time of the diagnostic tests (false-negative rates 11%-44% [95% confidence interval 1%-69%]). Twelve percent of patients apparently failed to take the prescribed NOAC prior to the acute event. Only 5.7% (9/159) of patients in the 4.5-hour time window received thrombolysis, and NOAC treatment was documented as main reason for not administering thrombolysis in 52.7% (79/150) of patients. Conclusion NOAC treatment currently poses a significant barrier to thrombolysis in ischemic stroke. Because nonspecific coagulation test results within normal range have a high false-negative rate for detection of relevant drug concentrations, rapid drug-specific tests for thrombolysis decision-making should be established.

scholarly journals Estimated glomerular filtration rate may be an independent predictor for clinical outcomes regardless of acute kidney injury complication in the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258665
Author(s):  
Ryohei Horie ◽  
Yuri Endo ◽  
Kent Doi
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Renal Dysfunction ◽  
Clinical Outcomes ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Composite Outcome

Study objective Acute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting. Methods Adult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category. Results Among 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45–2.05], 1.36 [1.16–1.59], 1.66 [1.39–2.00], 1.73 [1.32–2.28], and 2.71 [1.73–4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD. Conclusions Estimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.

scholarly journals Double trouble: ciclosporin–simvastatin coinduced rhabdomyolysis

2019 ◽  
Vol 12 (11) ◽  
pp. e225971 ◽  
Author(s):  
Yakeen Hafouda ◽  
Abhishek Sharma ◽  
Vincent Li ◽  
Paul Devakar Yesudian
Keyword(s):  
Multiple Sclerosis ◽  
Acute Kidney Injury ◽  
Filtration Rate ◽  
Blood Count ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Full Blood Count ◽  
Normal Range ◽  
Blood Tests

A 73-year-old woman presented with an acute exacerbation of her long-standing psoriasis. Ciclosporin was commenced due to the severity of her symptoms resulting in remission within 2 weeks. Full blood count, urea and electrolytes following initiation of treatment were unremarkable, although she complained of muscle aches, which was attributed to her known multiple sclerosis. Three weeks later she was admitted to the hospital with diarrhoea and vomiting. Repeat blood tests revealed raised creatinine (528 μmol/L (normal range (NR) n=45–84 μmol/L)), urea (32.6 mmol/L (NR 2.5–7.8 mmol/L)) and creatine kinase (6792 IU/L (NR 25–200 IU/L)) levels and reduced estimated glomerular filtration rate of 7. A diagnosis of acute kidney injury secondary to rhabdomyolysis was made due to an interaction between ciclosporin and simvastatin, precipitated by the dehydration from gastroenteritis. Haemofiltration was required to stabilise her renal function and she made a complete recovery.

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