In Hospital Bleeding Management
|
|
- Britton Houston
- 5 years ago
- Views:
Transcription
1 In Hospital Bleeding Management Geno J Merli, MD, MACP, FSVM, FHM Professor Medicine & Surgery Co-Director Jefferson Vascular Center Sidney Kimmel Medical College Thomas Jefferson University Hospitals
2 Disclosure Financial Relationships Geno J. Merli, MD, MACP, FHM, FSVM Jannsen: Research (Medically ill) Bristol-Meyer Squibb: Research (Jeff-Fast) Portola: Research (Medically ill) LoweRisk LLC, Co-Chief Development Officer
3 Assess Patient Anticoagulant LABs Imaging Consultation Intervention Warfarin IIa Inhibitor TSOAC Xa Inhibitor TSOAC
4 Assess Patient History & Physical Anticoagulant LABs Imaging Consultation Drug Class Indication Last Dose ½ Life Clearance CBC As Indicated PTT/PT By H&P SCr LFTs Thrombin Time As Indicated By H&P
5 Laboratory Testing Target Specific Oral Agents Lab Test Useful Lab test Strong ECT Dabigatran Rivaroxaban Apixaban Edoxaban TT Chromo* anti-xa PT# Chromo* anti-xa Chromo* anti-xa aptt Weak PT/INR * Chromogenic assay # PT reagent neoplastin has most linear correlation Palladino M et al: Am J Hem 87 Suppl:S127, 2012
6 Target Specific Anticoagulants Key Points Rivaroxaban Apixaban Edoxaban Dabigatran Target Factor Xa Factor Xa Factor Xa Factor IIa T ½ 7-11 hrs 12 hrs 6-11 hrs single doses 9-10 hrs multiple doses hrs Clearance 30% Renal 60% Liver 25% Renal 75% Liver 33% Renal 60% Liver 80% Renal Metabolism CYP 450 CYP3A4 CYP2J2 CYP3A4 No No P-GP Yes Yes Yes Yes Dialysis removes 60% Dabigatran
7 Intervention Warfarin Vit K + 4 PCC Vit K + 3 PCC FFP rf VIIa IIa Inhibitor TSOAC Dialysis Idarucizumab Xa Inhibitor TSOAC Vit K + 4 PCC Vit K + 3 PCC Andexanet Goals of Intervention 1. Fluid Resuscitation 2. Provide Rescue Clotting Factors 3. Increase Production of Normal Clotting Factors 4. Provide Anticoagulant Reversing Factor
8 Liver Function Coagulation Factors Vitamin K Warfarin Vitamin K Utilization Reduced Vitamin K Dependent Factors Half-Life II (60 hrs) VII (4-6 hrs) IX (24 hrs) X (48-72 hrs) C (8 hrs) S (30 hrs Warfarin ½ Life: 35 hrs
9 Blood Products Warfarin Anticoagulated Patient Product Factors Dosing Vitamin K # II, VII, IX, X, Protein C&S FFP * II, VII, IX, X, Protein C&S 10 mg, IV 10 mg, PO 15 cc/kg over 3 to 6 hrs, 250 cc/unit 3 Factor PCC* II, IX, X 50 U/kg 4 Factor PCC* II, VII, IX, X 50 U/kg Protein C&S rf VIIa* VII (activated) 15 mcg/kg # IV= Effect 12 hrs, PO= Effect 24 hrs * Immediate affect Prothrombin Time (INR)
10 Dabigatran Reversal 4 Factor Prothrombin Complex Concentrate Ecrin Clotting Time PCC Placebo Dabigatran 150mg BID PCC or Placebo Eerenberg E, et al Circulation 2011;124:
11 Four Factor vs Three Factor PCC Rivaroxaban Reversal Agent Reduction PT (sec) Beriplex (50 IU/kg) Four Factor Profilnine (50 IU/kg) Three Factor 2.5 sec 3.5 sec sec Rivaroxaban 20mg, BID x 4 days 30 minute following infusion effect noted Levi M, et al Abstract ISTH July 2013
12
13 Idarucizumab DEVELOPMENT Monoclonal antibody then humanized and directly expressed as a Fab fragment in hamster cells PROPERTIES Potent binding affinity ~350 times higher than binding of dabigatran to thrombin No procoagulant or anticoagulant effects expected Short half life Intravenous administration, immediate onset of action EXPECTED LOW RISK OF ADVERSE REACTIONS No Fc receptor binding No endogenous targets Fully humanized antibody fragment (Fab) Glund S et al. AHA Abstr 17765; Schiele F et al. Blood 2013;121:
14 Idarucizumab Healthy Volunteers dtt (s) End of idarucizumab injection (5-min infusion) Dabigatran + placebo Dabigatran plus: Placebo (n=9) 2 g idarucizumab (day 4) (n=9) 4 g idarucizumab (day 4) (n=8) Normal upper reference limit (n=86) Mean baseline (n=86) Dabigatran Antidote Time after end of infusion (hours) Glund S et al. AHA Abstr 17765
15 Dilute Thrombin Time Ecrin Clotting Time 51 Serious Bleeding 51 Serious Bleeding Two 2.5 Gram IV, 15 mins apart Pollack C, et al NEJM 2015
16 Andexanet Alfa Recombinant Modified Version Human FXa Acts as a FXa decoy and retains high affinity for all FXa inhibitors GLA domain removed to prevent anticoagulant effect S419 A419 FXa Inhibitor High affinity retained GLA S S Catalytic Domain Activity eliminated to prevent thrombin generation N-terminal residues retained to reduce immunogenicity Ansell J. Nat Med. 2013;19(4)402.
17 Andexanet Alfa: Apixaban Phase II Apixaban 5mg bid x 6 d prior to andexanet/placebo bolus 420mg bolus + 4mg/min infusion over 2 hours: > 90 % reversal at 2 minutes > 90 % reversal at 2 hours Highly statistically significant Reversal sustained throughout antidote infusion Anti-FXa activity returns to normal decay curve after termination of infusion Well tolerated; no thrombotic events or serious adverse events reported No antibodies to FXa or FX detected Similar activity against rivaroxaban and enoxaparin Anti-FXa (ng/ml) End of Bolus Anti-FXa Activity End of Infusion Placebo (Cohorts 1-3, n=9) 420mg bolus only (n=6) 420mg bolus + 480mg infusion (n=6) Time after bolus in hours Crowther MA, et al. J Thromb Haemost. 2013;11:AS20.
18 Andexanet Alfa: Rivaroxaban Phase II Rivaroxaban 20mg qd x 6 d prior to andexanet/placebo 800mg bolus + 8mg/min infusion over 2 hours: - > 90% reversal at 2 minutes - > 90 % reversal at 2 hours - Highly statistically significant Reversal sustained throughout antidote infusion - Anti-FXa activity returns to normal decay curve after termination of infusion Well tolerated; no thrombotic events or serious adverse events reported No antibodies to FXa or FX detected Anti-FXa (ng/ml) End of Bolus Anti-FXa Activity End of Infusion Placebo (Cohorts 1-3, n=9) 800mg bolus + 960mg infusion (n=6) Time after bolus in hours Crowther MA, et al. Blood. 2013;122:A3636.
19 Andexanet Alfa: Enoxaparin Phase II Anti-FXa Activity Hit clinical threshold for enoxaparin reversal ( 0.2 IU/ml) Restoration of thrombin generation within normal range Well tolerated; no thrombotic events or serious adverse events reported No antibodies to FXa or FX detected Anti-FXa (IU/mL) 0.5 End of Bolus AnXa vs. Placebo *p<0.0001; **p<0.005 Lower limit of detection Placebo (Cohorts 1-3, n=9) 210mg bolus only (Cohort 1, n=6) 420mg bolus only (Cohort 2, n=6) 210mg (Lyo) bolus only (Cohort 3, n=6) Time after bolus in hours 22 Crowther MA, et al. J Thromb Haemost. 2014;12(suppl 1):7.
20 Bleeding Anticoagulation ICH GI/GU Emergent Surgery Emergent Procedure Trauma Assess Patient Anticoagulant LABs Imaging Consultation Intervention Warfarin IIa Inhibitor TSOAC Xa Inhibitor TSOAC
21
DOACs Can Be Reversed!
1 DOACs Can Be Reversed! AC Forum 14 th National Conference April 21, 2017 Adam Cuker, MD, MS Perelman School of Medicine University of Pennsylvania 2 Full disclosures (last 12 months) Research support
More informationDeep dive into anticoagulant reversal In 20 minutes so we won t dive too deep. Mark Crowther on behalf many Some slides modified from other sources
Deep dive into anticoagulant reversal In 20 minutes so we won t dive too deep Mark Crowther on behalf many Some slides modified from other sources 1 Disclosures Major disclosure: Paid consulting with Portola,
More informationMark Crowther, MD, MSc, FRCPC. Co-authors. Professor of Medicine, McMaster University, Canada
Reversal of Enoxaparin-Induced Anticoagulation in Healthy Subjects by Andexanet Alfa (PRT064445), An Antidote for Direct and Indirect fxa Inhibitors A Phase 2 Randomized, Double-Blind, Placebo Controlled
More informationReverse the New Anticoagulants? Mitchell J Daley, PharmD, BCPS
Reverse the New Anticoagulants? Mitchell J Daley, PharmD, BCPS Clinical Pharmacy Specialist, Critical Care University Medical Center Brackenridge / Dell Seton Medical Center at the University of Texas
More informationManagement of Bleeding in the Anticoagulated Patient Short Snappers CSIM 2015 Elizabeth Zed, MD, FRCPC October 17, 2015
+ Management of Bleeding in the Anticoagulated Patient Short Snappers CSIM 2015 Elizabeth Zed, MD, FRCPC October 17, 2015 + Disclosures Off label use of PCC and apcc will be discussed My centre participates
More informationOverview of Reversal Agents in Development
Overview of Reversal Agents in Development Michael B Streiff, MD FACP Associate Professor of Medicine and Pathology Medical Director, Johns Hopkins Anticoagulation Service Chairman, VTE Guideline Committee,National
More informationUPDATE ON SPECIFIC ANTIDOTES FOR TARGET-SPECIFIC ORAL ANTICOAGULANTS
UPDATE ON SPECIFIC ANTIDOTES FOR TARGET-SPECIFIC ORAL ANTICOAGULANTS Junporn Kongwatcharapong (Pharm. D.) Clinical Pharmacist, Siriraj Hospital OUTLINE Introduction Approach to the management of TSOACs
More informationNovel Anti-coagulant Agents. David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan
Novel Anti-coagulant Agents David G Hovord BA MB BChir FRCA Clinical Assistant Professor University of Michigan Objectives Provide an overview of the normal coagulation, including perioperative testing
More informationDOACs: When and how to measure their anticoagulant effect
DOACs: When and how to measure their anticoagulant effect Stavroula Tsiara MD, PhD, FRCP Associate Professor of Internal Medicine University of Ioannina, Greece NOACs NOACs, TSOACs, DOACs (ISTH) Target
More informationA specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa
A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa Lu G, Deguzman FR, Hollenbach SJ, et al. Department of Biology, Portola Pharmaceuticals Inc.,
More informationNew Anticoagulants Linda Liu, M.D.
Difficult Task New Anticoagulants Professor UCSF Dept of Anesthesia 15 minutes! Emphasis on 2 new oral anticoagulants Dabigatran Rivaroxaban Relation to anesthesia Rapid reversal Regional anesthesia UC
More informationAnticoagulation in VTE The Haematologist s Perspective. Dr. M.D. Maina FRCP Edin.
Anticoagulation in VTE The Haematologist s Perspective Dr. M.D. Maina FRCP Edin. Disclosures None The coagulation process that leads to haemostasis involves a complex set of reactions involving approximately
More informationUpdate on the Direct Oral Anticoagulants (DOACs)
Update on the Direct Oral Anticoagulants (DOACs) J. Randle Adair DO, PhD Internal Medicine New Mexico Cancer Center & Co-Chair, Anticoagulation Subcommittee Presbyterian Healthcare Services (PHS) Attending,
More informationDOAC s and Implications on Laboratory Results. Kandice Kottke-Marchant, MD, PhD Cleveland Clinic
DOAC s and Implications on Laboratory Results Kandice Kottke-Marchant, MD, PhD Cleveland Clinic Anticoagulants Heparin Low Molecular Weight Heparins enoxaparin, fragmin Heparin pentasaccharide - fondaparinux
More informationNew Insights into the Diagnosis & Management of Venous Thromboembolism (VTE) Michael Miller, M.D.
New Insights into the Diagnosis & Management of Venous Thromboembolism (VTE) Michael Miller, M.D. Professor of Cardiovascular Medicine University of Maryland School of Medicine Copyright A.P. Wheeler 2009
More informationManaging Coagulation Abnormalities Linda Liu, M.D.
Managing Coagulation Abnormalities Professor UCSF Dept of Anesthesia UC SF 1 Difficult Task Coagulation Abnormalities 30 minutes Emphasis on 2 new oral anticoagulants Dabigatran Rivaroxaban UC SF 2 UC
More informationPraxbind. (idarucizumab) New Product Slideshow
Praxbind (idarucizumab) New Product Slideshow Introduction Brand name: Praxbind Generic name: Idarucizumab Pharmacological class: Humanized monoclonal antibody fragment Strength and Formulation: 2.5g/50mL;
More informationTSOAC Case Study 1. Question. TSOAC Case Study 1 Continued
TSOAC Case Study 1 An otherwise healthy 56-year-old man presents to the emergency department with left leg pain and swelling for the last 3 days. Compression ultrasonography confirms left common femoral
More informationApheresis Anticoagulant Removal. Oluwatoyosi Onwuemene, MD MS May 6th, 2017
Apheresis Anticoagulant Removal Oluwatoyosi Onwuemene, MD MS May 6th, 2017 Talk Outline Case presentation Factors associated with drug removal TPE s effects on hematologic parameters Anticoagulant properties
More informationUW Medicine Alternative Monitoring for Antithrombotic Agents
Tags: monitoring alternative monitoring SUMMARY OF ANTICOAGULATION LAB TESTS AT UWMedicine Description Order Code Specimen Collection Availability Turn-Around Time Anti Xa Based Tests antixa for heparin
More informationUP AND COMING ANTICOAGULANTS AND HEMOSTASIS AGENTS
UP AND COMING ANTICOAGULANTS AND HEMOSTASIS AGENTS Jeffrey I Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis Heart & Stroke Foundation/
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa
More informationEvaluation of Complex Coagulation Cases: Case-Based Illustrations of Important Issues
Evaluation of Complex Coagulation Cases: Case-Based Illustrations of Important Issues Kristi J. Smock, MD Associate Professor of Pathology University of Utah Health Sciences Center Medical Director, Hemostasis/Thrombosis
More informationTHE NOVEL ORAL ANTICOAGULANTS
IDEAL ANTITHROMBOTIC AGENT THE NOVEL ORAL ANTICOAGULANTS Kristin Jochmans MD, PhD Dienst Hematologie - Universitair Ziekenhuis Brussel Efficacious (in arterial and venous disease) Safe (no toxicity low
More informationSEMI New Generation of Anti Thrombolytics
SEMI New Generation of Anti Thrombolytics Dr. T. S. Srinath Kumar Coagulation Cascade and Site of Action of Various Anticoagulants Warfarin inhibits synthesis of factor II, VII, IX and X including protein
More informationBETRIXABAN TO PREVENT PE, DVT, STROKE: MEDICALLY ILL PATIENTS Samuel Z. Goldhaber, MD Director, Thrombosis Research Group Section Head, Vascular
BETRIXABAN TO PREVENT PE, DVT, STROKE: MEDICALLY ILL PATIENTS Samuel Z. Goldhaber, MD Director, Thrombosis Research Group Section Head, Vascular Medicine Cardiovascular Division Brigham and Women s Hospital
More informationTuesday, March 20, Oppenheimer & Co. Annual Healthcare Conference
ca Tuesday, March 20, 2018 Oppenheimer & Co. Annual Healthcare Conference Forward-Looking Statements This presentation contains forward-looking statements within the meaning of the Private Securities Litigation
More informationLaboratory investigation in the Bleeding Patient. Dr Craig Taylor Consultant Haematologist May 2016
Laboratory investigation in the Bleeding Patient Dr Craig Taylor Consultant Haematologist May 2016 Introduction Bleeding is common May consume significant resources Crossmatched blood Lab results may be
More informationManaging the Risks Associated with Anticoagulant Therapy. Steve McGlynn Specialist Principal Pharmacist (Cardiology) NHS Greater Glasgow and Clyde
Managing the Risks Associated with Anticoagulant Therapy Steve McGlynn Specialist Principal Pharmacist (Cardiology) NHS Greater Glasgow and Clyde Background Identified as high risk medicines Wide range
More informationPharmacology Lecture 5. Anticoagulants
Pharmacology Lecture 5 Anticoagulants General overview Anti-thrombotic Drugs Antiplatlets Anticoagulants Fibrinolytics Anticoagulants Indirect Thrombin Inhibitors Anti-thrombotic effect is exerted by interaction
More informationLaboratory Testing Issues for Protein C, Protein S and Antithrombin Assays
Laboratory Testing Issues for Protein C, Protein S and Antithrombin Assays Richard A. Marlar Ph.D. University of Oklahoma THSNA Meeting- Chicago, IL April 14-16, 2016 DISCLOSURE Richard A. Marlar, PhD
More informationLaboratory Monitoring of Anticoagulation
Michael Smith, Pharm. D., BCPS, CACP East Region Pharmacy Clinical Manager Hartford HealthCare Learning Objectives Explain the role of common laboratory tests used in monitoring of anticoagulation therapy.
More informationBlood transfusion in special situations and poly-trauma. Dr Marina Karakantza Consultant Haematologist in Transfusion Medicine, LTHT
Blood transfusion in special situations and poly-trauma Dr Marina Karakantza Consultant Haematologist in Transfusion Medicine, LTHT Uncontrolled bleeding is a major preventable cause of death in trauma
More informationOmar A. Elkashef, MD
DVT Prophylaxis in Orthopedic Surgery By Omar A. Elkashef, MD Kasr Al- aini About VTE Venous thromboembolism encompasses deep vein thrombosis (DVT) and pulmonary embolism VTE is common and PE is a potentially
More informationPlasma Testing in the Clinical Coagulation Laboratory: New drugs, new problems.
Test Plasma Testing in the Clinical Coagulation Laboratory: New drugs, new problems. Karen A. Moffat BEd, MSc, ART, FCSMLS(D) Technical Specialist, Coagulation, HRLMP Assistant Professor, Department of
More informationVenous Thromboembolism Prophylaxis after Major Elective Orthopedic Surgery
Venous Thromboembolism Prophylaxis after Major Elective Orthopedic Surgery Tony Wan, MD, FRCPC Clinical Instructor, Division of General Internal Medicine Department of Medicine, University of British Columbia
More informationPharmacotherapy Management in Patients with Extracorporeal Membrane Oxygenation
Pharmacotherapy Management in Patients with Extracorporeal Membrane Oxygenation Ayesha Ather, PharmD, BCPS College of Pharmacy, Adjunct Assistant Professor University of Kentucky Faculty Disclosure I have
More informationIf not heparin for bypass then what? Dr Tony Moriarty Consultant Cardiac Anaesthetist Birmingham United Kingdom
If not heparin for bypass then what? Dr Tony Moriarty Consultant Cardiac Anaesthetist Birmingham United Kingdom Heparin Discovered 1916, commercial available 1935 Heparin Is there an alternative, not really
More informationLina Al-Lawama. Rama Al-Ashqar. Malik Al-Zohlof
2 Lina Al-Lawama Rama Al-Ashqar Malik Al-Zohlof Anticoagulant drugs Recap Last lecture we were talking about antiplatelet drugs, we mentioned 5 drugs : Aspirin which is used alone with patents that have
More informationMark Blostein, MD Director, Anticoagulation Clinic and Coagulation Laboratories Jewish General Hospital McGill University Montreal, Canada
Mark Blostein, MD Director, Anticoagulation Clinic and Coagulation Laboratories Jewish General Hospital McGill University Montreal, Canada OBJECTIVES 1. Understand how Warfarin can be reversed 2. Understand
More informationMarcia L. Zucker, Ph.D. ZIVD LLC
Marcia L. Zucker, Ph.D. ZIVD LLC 1 Monitoring hemostasis Bleeding Clotting 2 Picture courtesy of Helena Laboratories 3 Extrinsic Pathway Monitor with ACT / aptt WARFARIN Monitor with PT Common Pathway
More informationLaboratory testing for Direct Oral Anticoagulants (DOACs): Are we ready?
The Hong Kong College of Pathologists, Incorporated in Hong Kong with Limited Liability Volume 12, Issue 1 January 2017 Editorial note: In this topical update, Dr Rock Leung reviews the testing strategy
More informationiccnet CHSA Clinical Protocol - HEPARIN
Name: iccnet CHSA Clinical Protocol - HEPARIN This clinical guideline or clinical protocol is based on a review of best practice evidence and expert opinion. It is intended to guide practice and does not
More informationa unit of Dr Bharat S Mody Director Chief Arthroplasty Surgeon Centre for Knee & Hip Surgery Dr Pankaj Patni Orthopaedic Surgeon Dr Sunil Dewangan
Centre for Knee & Hip Surgery Arthroscopy a unit of Arthroplasty Dr Bharat S Mody Director Chief Arthroplasty Surgeon Dr Sunil Dewangan Dr Prakash Tekwani Dr Rahul Khanna Dr Pankaj Patni Orthopaedic Surgeon
More informationAMAG Acquires Perosphere Pharmaceuticals Inc. December 13, 2018
AMAG Acquires Perosphere Pharmaceuticals Inc. December 13, 2018 1 Forward-Looking Statements This presentation contains forward looking statements within the meaning of the Private Securities Litigation
More informationAnticoagulation Safety
Anticoagulation Safety 2/12/13 Latha Sivaprasad, MD, FHM, FACP Associate Chief Medical Officer Chief Patient Experience Officer Laura O Brien RN, MA, CCRN Clinical Nurse Specialist Outline The journey
More informationThe Combined Use of Bypassing Agents with Antithrombin Reduction in Plasma of Hemophilia A and B Patients with Inhibitors
Venkat Living Venkat with Hemophilia Living with Hemophilia The Combined Use of Bypassing Agents with Antithrombin Reduction in Plasma of Hemophilia A and B Patients with Inhibitors Tami Livnat 1, Alfica
More informationDisclosures. The Yin and Yang of Clotting and Anticoagulation: VTE Management in A New JCAHO Era. Objectives
The Yin and Yang of Clotting and Anticoagulation: VTE Management in A New JCAHO Era Kathryn Hassell, M.D. Professor of Medicine Division of Hematology University of Colorado Denver Health Sciences Center
More informationScientific Workshop. Melbourne Convention and Exhibition Centre Level 2, Meeting Rooms 218 and 219 Melbourne
Scientific Workshop Melbourne Convention and Exhibition Centre Level 2, Meeting Rooms 218 and 219 Melbourne 12 th November 2016 Australasian Society of Thrombosis and Haemostasis The Australasian Society
More informationISIS PHARMACEUTICALS. ISIS-FXI Rx Program Update. Webcast December 8, 2014
ISIS PHARMACEUTICALS ISIS-FXI Rx Program Update Webcast December 8, 2014 Introduction Stan Crooke, M.D., Ph.D. CEO and Chairman, Isis Pharmaceuticals 2 Forward Looking Language Statement This presentation
More informationSession 1 Topics. Vascular Phase of Hemostasis. Coagulation Pathway. Action of Unfractionated Heparin. Laboratory Monitoring of Anticoagulant Therapy
~~Marshfield Labs Presents~~ Laboratory Monitoring of Anticoagulant Therapy Session 1 of 4 Session 1 Topics Review of coagulation and the vascular phase of hemostasis Unfractionated heparin Low molecular
More informationAntithrombosis Management for Pediatric VAD and Beyond
Antithrombosis Management for Pediatric VAD and Beyond Christina VanderPluym M.D. Director of Ventricular Assist Device and Cardiac Antithrombosis Program Boston Children s Hospital, USA Disclosures I
More informationANTICOAGULANT THERAPY ANTICOAGULANT THERAPY REVISITED Thrombosis is a complication of underaggressive anticoagulant therapy
ANTICOAGULANT THERAPY REVISITED 2004 or, Which one(s) of these (#$%$#!@#^) drugs should be the one(s) I use, and for what? ANTICOAGULANT THERAPY One of most common treatments in hospital & out 2 nd most
More informationCoagulation in perspective: Blood management. Objectives
Coagulation in perspective: Blood management Julie Wegner, PhD jawrbl@gmail.com Objectives To gain a basic understanding of the following: 1. Coagulation components and processes Why patients bleed. 2.
More informationWFH 2014 World Congress Medical Free Paper 8 ALN AT3: An Investigational RNAi Therapeutic Targeting Antithrombin for the Treatment of Hemophilia
WFH 214 World Congress Medical Free Paper 8 ALN AT3: An Investigational RNAi Therapeutic Targeting Antithrombin for the Treatment of Hemophilia May 15, 214 Akin Akinc, PhD Antithrombin and ALN-AT3 Program
More informationPROPHYLAXIS IN THE ORTHOPEDIC PATIENT: Martin H. Ellis MD Hematology Institute and Blood Bank Meir Medical Center Kfar Saba
VENOUS THROMBOEMBOLISM PROPHYLAXIS IN THE ORTHOPEDIC PATIENT: Martin H. Ellis MD Hematology Institute and Blood Bank Meir Medical Center Kfar Saba OVERVIEW Biochemistry of coagulation Pathogenesis of VTE
More informationLaboratory Monitoring of Unfractionated Heparin Therapy
1 PATHOLOGY & LABORATORY MEDICINE December, 2015 Laboratory Monitoring of Unfractionated Heparin Therapy On November 18, 2015, the Thrombosis and Hemostasis Laboratory transitioned from the aptt to the
More informationArt by C. Michael Gibson, MS, MD
P o rto l a 2 0 14 the art of science for the benefit of patients Art by C. Michael Gibson, MS, MD creating innovation. breakthrough medicines. value. creating a growth company 100+ strong Portola Pharmaceuticals
More information3 : 34. Pankaj Manoria, P C Manoria, Bhopal
3 : 34 Newer Antithrombins and anticoagulants Introduction Thrombosis is a leading cause of morbidity and mortality but for decades, anticoagulant therapy has usually consisted of unfractionate heparin
More informationPhysician Orders - Adult
Physician Orders - Adult attach patient label here Title: Direct Thrombin Inhibitor (DTI) Protocol Orders Height: cm Weight: kg Allergies: [ ] No known allergies [ ]Medication allergy(s): [ ] Latex allergy
More informationBleeding Emergencies. Gregory W. Hendey, MD, FACEP Professor of Clinical Emergency Medicine UCSF Fresno
Bleeding Emergencies Gregory W. Hendey, MD, FACEP Professor of Clinical Emergency Medicine UCSF Fresno Objectives To discuss indications and agents used for reversal of coagulopathy To apply those principles
More informationLinking in silico and in vitro experiments to identify and evaluate a biomarker for enoxaparin activity
Linking in silico and in vitro experiments to identify and evaluate a biomarker for enoxaparin activity Abhishek Gulati What is enoxaparin? Low molecular weight heparin anticoagulant Used to minimise the
More informationEvidence Update Evidence update on the use of oral anticoagulants in clinical practice
1-10 Evidence Update Evidence update on the use of oral anticoagulants in clinical practice Chandima Kulathilake 1 1Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura,
More informationThe New Oral Anticoagulants: what emergency physicians need to know HK College of Emergency Medicine Joint Clinical and Didactic Lectures 7 Aug 2013
The New Oral Anticoagulants: what emergency physicians need to know HK College of Emergency Medicine Joint Clinical and Didactic Lectures 7 Aug 2013 Outline of talk 1. What are new oral anticoagulants
More informationThe Role Of Point of Care Coagulation Testing (POCCT) in Patient Blood Management. Elham Khalaf Adeli
The Role Of Point of Care Coagulation Testing (POCCT) in Patient Blood Management Elham Khalaf Adeli Overview PBM, bleeding management, Coagulation POC Testing Review of laboratory conventional coagulation
More informationVenous thromboembolism (VTE) Can Biomarkers Help to Guide Duration of Therapy After VTE? New Chest Guidelines 2016
Venous thromboembolism (VTE) Can Biomarkers Help to Guide Duration of Therapy After VTE? Marlene Grenon, MD Associate Professor of Surgery University of California San Francisco UCSF Vascular Surgery Symposium
More informationPlatelet Factor IV- Heparin Antibodies. Presenter: Michael J. Warhol, M.D.
Platelet Factor IV- Heparin Antibodies Presenter: Michael J. Warhol, M.D. Learning Objectives Describe the mechanism of interaction between Heparin and Platelet Factor 4 Review the chemistry of Heparin
More informationNew Drug Evaluation: Betrixaban Capsules
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationAlternative Haemostatic Agents in the Management of Obstetric Haemorrhage
Alternative Haemostatic Agents in the Management of Obstetric Haemorrhage Clinical Associate Professor Nolan McDonnell School of Medicine and Pharmacology, School of Women s and Infants Health University
More informationDISCLOSURE Elaine Gray, NIBSC
Monitoring Methods for Direct Thrombin Inhibitors Elaine Gray, PhD Haemostasis Section Biotherapeutics Group NIBSC DISCLOSURE Elaine Gray, NIBSC Relevant Financial Relationship(s) NONE Off Label Usage
More informationEvaluation of AMG 531 Efficacy in Splenectomized Patients with Chronic ITP in a Randomized Placebo- Controlled Phase 3 Study
Evaluation of AMG 531 Efficacy in Splenectomized Patients with Chronic ITP in a Randomized Placebo- Controlled Phase 3 Study Plenary Session at ASH 2007 Presented by Terry B. Gernsheimer Madeleine Verhovsek
More informationBetrixaban (Bevyxxa) A Direct-Acting Oral Anticoagulant Factor Xa Inhibitor
Betrixaban (Bevyxxa) A Direct-Acting Oral Anticoagulant Factor Xa Inhibitor Jessica W. Skelley, PharmD, BCACP; Angela R. Thomason, PharmD, BCPS; and Jeffery C. Nolen, PharmD Candidate INTRODUCTION Venous
More informationBivalirudin (Angiomax ) vs. Heparin during Peripheral Vascular Interventions: Which is Better and How to Decide?
Bivalirudin (Angiomax ) vs. Heparin during Peripheral Vascular Interventions: Which is Better and How to Decide? Vinod Nair MD FACC FSCAI Cardiovascular Ins6tute of the South, Houma Financial Disclosure:
More informationNEW ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS IN THE FOOT AND ANKLE
NEW ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS IN THE FOOT AND ANKLE Matthew Q. McCammon, DPM INTRODUCTION Venous thromboembolism (VTE) is a common cause of morbidity and mortality. Each
More informationDirect anticoagulation therapy
Direct anticoagulation therapy Pan-Arab Meeting & Saudi Society of Hematology Dr Ihab Alhemaidi MBBS MRCP(Lond UK) FRCPath. Fellow of the Royal Society of Medicine Consultant Adult hematology/bmt Section
More informationWaterfall/ Cascade Model:1960 s. Coagulation Challenges During the Perioperative Period
Coagulation Challenges During the Perioperative Period Professor Dept Anesthesia and Perioperative Care UC San Francisco Waterfall/ Cascade Model:1960 s Intrinsic Pathway Kallikrein fxii fxi Extrinsic
More informationDifferential effects of the direct thrombin inhibitor dabigatran etexilate vs warfarin on platelet function
Differential effects of the direct thrombin inhibitor dabigatran etexilate vs warfarin on platelet function Giulia Renda 1, Gelsomina Malatesta 1, Valentina Bucciarelli 1, Alessia Napoleone 1, Loredana
More informationHeparin. 4.2 Heparin
Heparin 4. Heparin 4.2 Heparin 5. aptt 5.2 aptt 5.3. -.2-7. 7.2 / , 2, 3, 4. 2. Q (NQMI) 3. 4. 5. 4, 5 Heparin (straight-chain anionic glycosaminoglycans) III (antithrombin III) (warfarin 8-2 ) heparin
More informationResults expression for tests used to measure the anticoagulant effect of new oral anticoagulants
Tripodi Thrombosis Journal 2013, 11:9 REVIEW Open Access Results expression for tests used to measure the anticoagulant effect of new oral anticoagulants Armando Tripodi Abstract Results of clotting tests
More informationThe novel anticoagulants: entering a new era. BOUNAMEAUX, Henri. Abstract
Article The novel anticoagulants: entering a new era BOUNAMEAUX, Henri Abstract During the past five decades, anticoagulant therapy has consisted of rapidly acting parenteral drugs (unfractionated heparin
More informationClinical Policy Guidelines. Management of patients on antithrombotic agents undergoing colonoscopy procedure following positive FOB test.
NHS GREATER GLASGOW AND CLYDE BOWEL SCREENING PROGRAMME Clinical Policy Guidelines Management of patients on antithrombotic agents undergoing colonoscopy procedure following positive FOB test. Date to
More informationLocal vasoconstriction. is due to local spasm of the smooth muscle (symp. reflex) can be maintained by platelet vasoconstrictors
Hemostasis Hemostasis ( hemo =blood; sta= remain ) is the stoppage of bleeding, which is vitally important when blood vessels are damaged. Following an injury to blood vessels several actions may help
More informationAcute Traumatic Coagulopathy
Jean-Francois Pittet, M.D. Depts of Anesthesia and Surgery Cardiovascular Research Institute University of California San Francisco Acute Traumatic Coagulopathy Plan 1. Description of the coagulation system
More informationDisclosures. Thromboelastography. TEG Methodology. TEG Output. Thromboelastography (TEG): Basics & Clinical Applications
Thromboelastography (TEG): Basics & Clinical Applications Paula J. Santrach MD Associate Professor, Laboratory Medicine Mayo Clinic Rochester, MN Disclosures Relevant financial relationships NONE Off label
More informationHematology Emergencies: Problems with Platelets
Hematology Emergencies: Problems with Platelets Christian Cable, MD, FACP Associate Professor of Medicine Division of Hematology & Oncology Texas A&M HSC College of Medicine Scott & White Healthcare Fundamentals
More informationEVOLUTION OF INHIBITOR TREATMENT
EVOLUTION OF INHIBITOR TREATMENT Flora Peyvandi Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico and University of Milan, Italy February
More informationUsing TEG in the ED, OR, and ICU. Don H. Van Boerum, MD, FACS
Using TEG in the ED, OR, and ICU Don H. Van Boerum, MD, FACS Trauma Surgeon, Director of Surgical Critical Care, Co-Director of Shock Trauma ICU, Intermountain Medical Center, Intermountain Healthcare
More informationThe Lancet Publishes Results from the Landmark Phase III Rivaroxaban Study RECORD2
News Release Bayer HealthCare AG Corporate Communications 51368 Leverkusen Germany Phone +49 214 30 1 www.news.bayer.com Venous Blood Clot Prevention after Hip Replacement Surgery: The Lancet Publishes
More informationAntithrombotic Therapies: Parenteral Agents
Antithrombotic Therapies: Parenteral Agents Christine A. Sorkness, Pharm.D. Professor of Pharmacy & Medicine (CHS) UW School of Pharmacy Clinical Pharmacist, Anticoagulation Clinic, Wm S. Middleton VA
More informationFactor Concentrates. More is better? Alexander Duncan MD Emory Medical Labs
Factor Concentrates. More is better? Alexander Duncan MD Emory Medical Labs Call from OR! Scenario -1 Patients is bleeding out! Don t ask why, what rate what s been done! We need blood now! What kind of
More informationGeneral News. Product Notes. Instrument Notice HELENA SALES FORCE TO: FROM: SUBJECT: HELENA POINT OF CARE ROUND-UP/US DOMESTIC DATE: 9/1/2009
TO: FROM: SUBJECT: HELENA SALES FORCE DATE: 9/1/2009 General News HELENA POINT OF CARE ROUND-UP/US DOMESTIC We have concluded a very large meeting with the AACC in Chicago. The leads have been processed
More informationLovenox weight calculator
P ford residence southampton, ny Lovenox weight calculator What Are the Treatments for Hemangioma on the Liver? Sciatic Nerve Surgery Recovery Time. How to Determine the Best Brand of Compression Stockings
More informationM1722 Hot Topics in Hemostasis
M1722 Hot Topics in Hemostasis Russell A. Higgins, MD, FCAP Karen A. Moser, MD, FCAP Objectives Describe the laboratory assays currently available to measure DOAC effect in individual patients. Evaluate
More informationBevyxxa (betrixaban) NEW PRODUCT SLIDESHOW
Bevyxxa (betrixaban) NEW PRODUCT SLIDESHOW Introduction Brand name: Bevyxxa Generic name: Betrixaban Pharmacological class: Factor Xa inhibitor Strength and Formulation: 40mg, 80mg; caps Manufacturer:
More informationCoagulation Laboratory: Methods, Standards & Cost Effective Testing Part 1
Coagulation Laboratory: Methods, Standards & Cost Effective Testing Part 1 Donna D. Castellone, MS, MT (ASCP) SH Clinical Project Manager Hematology and Hemostasis Siemens Healthcare Diagnostics Disclosures
More informationMarcia L. Zucker, Ph.D. ZIVD LLC
Marcia L. Zucker, Ph.D. ZIVD LLC 1 Explain why ACTs from different systems are not the same Develop a plan for switching from one ACT system to another Describe why ACT and aptt are not interchangeable
More informationEffect of Direct Thrombin Inhibitors, Bivalirudin, Lepirudin, and Argatroban, on Prothrombin Time and INR Values
Coagulation and Transfusion Medicine / DIRECT THROMBIN INHIBITOR EFFECT ON INR Effect of Direct Thrombin Inhibitors, Bivalirudin, Lepirudin, and Argatroban, on Prothrombin Time and INR Values Robert C.
More informationLABORATORY APPROACH TO BLEEDING DISORDERS DR NISHANTH PG 1 ST YEAR DEPARTMENT OF PATHOLOGY
LABORATORY APPROACH TO BLEEDING DISORDERS DR NISHANTH PG 1 ST YEAR DEPARTMENT OF PATHOLOGY 1 WHEN IS THE LAB REQUIRED TO INVESTIGATE FOR A POSSIBLE BLEEDING DISORDER? Clinically suspected bleeding tendency
More informationIndex. Autoimmune thrombocytopenic purpura (AITP), 100, 102, 105, 108, 187 Automated platelet counters, , 108
A Accuracy, 6, 7, 15, 46, 52, 53, 61, 75, 100, 143, 144, 149, 166, 176, 178 Acquired coagulation disorders, 111 115 Acquired platelet disorders, 99 108 ACT. See Activated clotting time (ACT) Activated
More informationThese handouts are only meant as a guide while you follow the presentation on the screen. Sometimes the speaker will change some of the slides.
These handouts are only meant as a guide while you follow the presentation on the screen. Sometimes the speaker will change some of the slides. If you would like the 1 slide per page handouts, please ask
More information