Hot topics in coagulation testing: Important considerations for testing children for bleeding/thrombotic disorders

Rahman, Marzia; George, Carly; Monagle, Paul

doi:10.1111/ijlh.13198

Cited by 4 publications

(2 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, discrete age-partitioned and age-appropriate reference intervals are likely needed for coagulation test in the paediatric population. 33 Consensus Recommendations…”

Section: Patient Selection For Doac Testingmentioning

confidence: 99%

2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

Adcock²,

et al. 2021

View full text Add to dashboard Cite

In 2018, the International Council for Standardization in Hematology (ICSH) published a consensus document providing guidance for laboratories on measuring direct oral anticoagulants (DOACs). Since that publication, several significant changes related to DOACs have occurred, including the approval of a new DOAC by the Food and Drug Administration, betrixaban, and a specific DOAC reversal agent intended for use when the reversal of anticoagulation with apixaban or rivaroxaban is needed due to life-threatening or uncontrolled bleeding, andexanet alpha. In addition, this ICSH Working Party recognized areas where additional information was warranted, including patient population considerations and updates in point-of-care testing. The information in this manuscript supplements our previous ICSH DOAC laboratory guidance document. The recommendations provided are based on (1) information from peer-reviewed publications about laboratory measurement of DOACs, (2) contributing author’s personal experience/expert opinion and (3) good laboratory practice.

show abstract

“…In addition, discrete age-partitioned and age-appropriate reference intervals are likely needed for coagulation test in the paediatric population. 33 Consensus Recommendations…”

Section: Patient Selection For Doac Testingmentioning

confidence: 99%

2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

Adcock²,

et al. 2021

View full text Add to dashboard Cite

show abstract

“…It is also eliminated via the kidneys; however, some of the elimination pathways are still unknown 27 , 28 . Alternate explanations for variability in dosing could be explained by differences in pentasaccharide sequence content within the vials 29 – 31 and the impact of developmental hemostasis 32 – 34 . As many of these factors are unmeasured in clinical practice, patient responses to unfractionated heparin therapy tend to be unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Individual variation in unfractionated heparin dosing after pediatric cardiac surgery

Hikino

Koido

Ide

et al. 2020

Sci Rep

View full text Add to dashboard Cite

We aimed to identify attributing factors to the interindividual variabilities of the infusion rates in unfractionated heparin therapy. We included patients who required unfractionated heparin therapy to achieve the target APTT after cardiac surgery between May 2014 and February 2018. Fifty-nine patients were included, of whom 8 underwent Blalock-Taussig shunt; 27, Glenn procedure; 19, Fontan procedure; 3, mechanical valve replacement; and 2, Rastelli procedure. Previously reported variables that influenced the response to unfractionated heparin treatment were initially compared, which included age; weight; sex; type of surgery; platelet count; fibrinogen, antithrombin III, total protein, albumin, alanine transaminase, and creatinine levels; and use of fresh frozen plasma. The type of surgical procedure was found to be significantly associated with the differences in heparin infusion rate (P = 0.00073). Subsequently, the variance explained by these factors was estimated through a selection based on the minimum Akaike information criterion value; models constructed by various combinations of the surgery types were compared. The model including the Blalock-Taussig shunt, Glenn procedure, and mechanical valve replacement showed the highest summed variance explained (29.1%). More than 70% of the interindividual variability in initial heparin maintenance dosing was unexplained.

show abstract

Current insights into the possible role of laboratory monitoring of effectiveness and safety of direct oral anticoagulants

Gilyarevsky

Vereina

Голшмид

2023

Racionalʹnaâ farmakoterapiâ v kardiologii

View full text Add to dashboard Cite

The article is devoted to the discussion of modern approaches to the use of laboratory methods to improve the tactics of using direct oral anticoagulants (DOACs) therapy. Clinical situations in which it may be reasonable to use data on the blood concentration of DOACs are given, including very old age, a marked deviation from the norm of body weight or impaired renal function. Data on the role of measuring the blood level of DOACs are considered in cases of the development of diseases or complications in which information is required on the preservation of the anticoagulant effect of DOACs, for example, in the development of severe bleeding or the need for urgent surgical intervention. The advantages and limitations of modern laboratory methods for assessing the blood concentration of DOACs are discussed. It is emphasized that one of the main advantages of using DOACs is the absence of the need to monitor laboratory parameters in most patients. Data from pharmacological studies are presented that may be useful in explaining the mechanisms that determine the higher safety of some DOACs compared to others. Promising methods for assessing the blood level of DOACs, as well as the possibility of using less specific reagents for assessing the concentration of DOACs, are considered. The possibility of using less specific, but more accessible methods for assessing the blood concentration of factor Xa inhibitors, in particular, a reagent for assessing the level of the antifactor, which is used to determine the blood level of heparin, is being considered. The opinions of experts on the role of assessing the blood level of DOACs and the possibility of tactics for selecting doses of DOACs based on laboratory analysis data are given.

show abstract

Hot topics in coagulation testing: Important considerations for testing children for bleeding/thrombotic disorders

Cited by 4 publications

References 38 publications

2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

Individual variation in unfractionated heparin dosing after pediatric cardiac surgery

Current insights into the possible role of laboratory monitoring of effectiveness and safety of direct oral anticoagulants

Contact Info

Product

Resources

About