INR = (patient PT/mean normal PT) ISI.

Size: px
Start display at page:

Download "INR = (patient PT/mean normal PT) ISI."

Transcription

1 The Relationship of the International Normalized Ratio () to the Prothrombin Time (PT) By: William DePond MD, President and Chief Medical Officer MEDLAB In 1983, it was determined that patients receiving long-term anticoagulant therapy may be subject to unnecessary risks of bleeding or thromboembolism because of variability in the commercial thromboplastins used to determine prothrombin time (PT) and consequent uncertainty about the actual intensity of anticoagulation. The accuracy of the PT was noted to be system-dependent showing variations in results due to marked variability in the response of commercial thromboplastin reagents to clotting factors (II, VII, X). This led to the introduction of the International Normalized Ratio (), a method developed to normalize the clotting time value by correcting for differences in reagent responsiveness. Thus, laboratory monitoring of oral anticoagulant therapy could be standardized. Each lot of thromboplastin is tested against an international standard and the relationship is expressed as the International Sensitivity Index (ISI). The uses the ISI to equate all thromboplastins to the reference thromboplastin through the following equation: = (patient PT/mean normal PT) ISI. This logarithmic relationship is easily seen in the table below comparing various ISI reagents and the variation of seconds compared to the. A patient with an of 2.0 (remember the s will be equivalent) will show a PT of 26.1 seconds using a sensitive ISI reagent (1.0) versus 16.0 seconds an insensitive ISI reagent (2.4). PT seconds vs. ISI ISI=1.0 ISI=1.6 ISI=2.0 ISI= Reagents with lower ISI values are more responsive to the effects of Warfarin therapy and thus have longer PTs. When a sample from a patient stabilized on Warfarin therapy is tested using two thromboplastin reagents with two different ISIs, the PT (seconds) will be higher with the more sensitive (lower ISI) thromboplastin. Conversely, the PT (seconds) will be lower with the less sensitive (higher ISI) reagent. Nevertheless, the values will be equivalent. The College of American Pathologists (CAP) Conference XXXI on Laboratory Monitoring of Anticoagulant Therapy published a recommendation that laboratories use thromboplastins with an ISI between 0.9 and 1.7.

2 The use of sensitive thromboplastins is supported by how variations (or errors) in ISI values influence the. Variations in ISI can occur due to inherent imprecision in the manufacturer-assigned ISI, changes during transportation or local instrument effect. A thromboplastin reagent with a lower ISI value results in a wider range of PT ratios to obtain a therapeutic. This enhances patient safety. Despite the system, significant inter-laboratory variation and inaccuracies persist in laboratories which can be can reduce by using a sensitive thromboplastin with an instrument-specific ISI value, determining the geometric mean normal PT for each lot of thromboplastin and ensuring the calculation uses the appropriate ISI for reagent lot. If a laboratory uses the PT (seconds) to trigger a critical value call to a clinician, when a change of thromboplastin reagents is made to one with a lower ISI, the laboratory will need to adjust the PT critical value. If a laboratory uses the for triggering a critical value call, then a change in thromboplastin reagent would have little impact to critical value reporting. The normal range for the for a healthy person is Recommendations for therapeutic levels of anticoagulation based on can be found in "Antithrombotic and Thrombolytic Therapy, 8th Ed: ACCP Guidelines", published in the June 2008 (Supplement) issue of Chest. An of 2.0 to 3.0 is recommended for most indications. The guidelines are helpful but do replace clinical judgment in monitoring patients, as patients vary in their response to oral anticoagulation. Such variations in patient response may be due to intrinsic factors such as genetic factors or extrinsic factors such as medications, disease processes and/or diet. The tables below show some of these factors and their impact on a patient s response to anticoagulation therapy.

3 Cytochrome P450 2C9 and VKORC1 Mutation Analysis Clinical Significance: Warfarin (coumadin) therapy is associated with significant complications because of its narrow therapeutic index and large interpatient dosage variation necessary to achieve an optimal therapeutic response. This variation is due to both genetic and environmental factors. A promoter variant (-1639 G>A) of the Vitamin K epoxide complex subunit 1 (VKORC1) accounts for 25%-44% of this variability and variants of the cytochrome P450 enzyme 2C9 (CYP2C9) account for 10%-15% of this variability. Identification of these Warfarin sensitive variants of the VKORC1 and the CYP2C9 genes may allow a more individualized therapy and reduced risk of bleeding complications. CYP2C9*2 or CYP2C9*3, vitamin K epoxide reductase (VKORC1) Metabolize coumarins slowly Metabolize coumarins slowly Twice as likely to have a laboratory or clinical adverse event Homozygous VKORC1 promoter polymorphism 1639 G>A (aka VKOR 3673, haplotype A, or haplotype*2) Reduce Warfarin dosage Reduce Warfarin dosage compared to genotype GG patients Condition Prothrombin time Partial thromboplastin time Bleeding time Platelet count Vitamin K deficiency or prolonged prolonged unaffected unaffected Warfarin Disseminated intravascular prolonged prolonged prolonged decreased coagulation Von Willebrand disease unaffected prolonged prolonged unaffected Hemophilia unaffected prolonged unaffected unaffected Aspirin unaffected unaffected prolonged unaffected Thrombocytopenia unaffected unaffected prolonged decreased Early Liver failure prolonged unaffected unaffected unaffected End-stage Liver failure prolonged prolonged prolonged decreased Uremia unaffected unaffected prolonged unaffected Congenital afibrinogenemia prolonged prolonged prolonged unaffected Factor V deficiency prolonged prolonged unaffected unaffected Factor X deficiency as seen prolonged prolonged unaffected unaffected in amyloid purpura Glanzmann's thrombasthenia unaffected unaffected prolonged unaffected Bernard-Soulier syndrome unaffected unaffected prolonged decreased

4 Antibiotics erythromycin inhibition of metabolism Avoid if possible, otherwise decrease Warfarin metronidazole inhibition of metabolism Avoid if possible, otherwise decrease Warfarin quinolones (enoxacin > ciprofloxacin > norfloxacin > nalidixic acid > ofloxacin) inhibition of metabolism; altered protein binding Avoid if possible, otherwise decrease Warfarin trimethoprim / sulfamethoxazole inhibition of metabolism; altered protein binding Avoid if possible, otherwise decrease Warfarin rifampin induction of metabolism Monitor, dose increase probably required Analgesics Anti-inflammatory s phenylbutazone inhibition of metabolism altered protein binding aspirin (high dose) direct prolongation of prothrombin time NSAIDs (except phenylbutazone) Lipid Lowering s Avoid: anti-platelet effect, increases peptic ulceration Anti-platelet effect, increases peptic ulceration. Significant risk but low dose aspirin may be justified for some clinical indications. - minor displacement interactions Cause peptic ulceration, reversible antiplatelet effect, avoid if possible but minimal pharmacokinetic interactions. clofibrate unknown Avoid cholestyramine binds Warfarin Colestipol has less effect than cholestyramine Neurological s Barbiturates induction of metabolism Potent enzyme inducer, will require a large increase in dose over several weeks carbamazepine induction of metabolism Potent enzyme inducer, will require a large increase in dose over several weeks Gastroenterological s cimetidine inhibition of metabolism Avoid: substitute another H2 antagonist Cardiovascular s amiodarone inhibition of metabolism May require decrease in dose, consider sotalol or other agent unless extrapyramidal symptoms indicate otherwise. quinidine unknown Nutritional Supplements Social s

5 vitamin K vitamin K Avoid, except when given to correct excess anticoagulation alcohol induction/inhibition of safe if intake is < 30 Gm/day metabolism Miscellaneous s disulfuram indirect potentiation Avoid heparin direct prolongation of prothrombin time Prolongation of 10-20% if activated partial thromboplastin time is in the therapeutic range antithyroid drugs altered catabolism of clotting Increased dose may be required factors sulfinpyrazone inhibition of metabolism altered protein binding anti-platelet effect Avoid Variable Enhanced Response to Warfarin Decreased Response to Warfarin Diet Malnutrition Foods high in vitamin K such as: Beef liver Pork liver Green tea Leafy green vegetables Medications and nutritional Quinidine Indomethacin Adrenal Anti-thyroid drugs Barbiturates Estrogen supplements Medical conditions corticosteroids Reduced vitamin K absorption as occurs in: Obstructive jaundice Hepatitis Cirrhosis Aluminum hydroxide Diabetes mellitus Edema Hyperlipidemia Hypothyroidism Most errors in plasma-based coagulation testing occur in the pre-analytical phase. A proper specimen is essential for accurate test results. The following table summarizes errors that can occur in specimen collection, transport, and storage.

6 Preanalytical Factor Potential Error Recommendation Blood collection tube additive Some additives will interfere with Use a collection tube containing 3.2% sodium coagulation test results. citrate. Order of draw Using a winged blood collection device for venipuncture Collecting a coagulation specimen from a vascular access device (VAD) Underfilling the blood collection tube Specimen storage time prior to prothrombin time (PT) test Specimen storage time prior to activated partial thromboplastin time (aptt) test Contamination from other additives could interfere with coagulation test results. Air that is collected into the blood specimen from the tubing dead space will alter the blood to anticoagulant ratio and may impact test results. Heparin contamination occurs if the line had been previously flushed with heparin. Ratio of blood to anticoagulant is altered, and the test result may be incorrect. Incorrect storage will alter patient test result. Incorrect storage will alter patient test result. Draw the coagulation tube (blue top) before tubes with other additives. Use a discard tube to collect a sufficient amount of blood to fill the tubing dead space before collecting the patient's specimen. If a VAD must be used, the line should first be flushed with 5 ml of saline, and then 5 ml of blood should be collected and discarded using a non-additive or coagulation tube as the discard tube. Allow the tube to completely fill so the ratio of blood to anticoagulant is 9:1. Specimen can be stored at room temperature (18-24 C) for up to 24 hours in an unopened collection tube. If stored longer than 24 hours, remove plasma and freeze at < -20 C. Must be centrifuged and tested within four hours of collection, or the plasma removed and frozen at < -20 C. Centrifuge within one hour of collection if patient is receiving unfractionated heparin.

One stage Prothrombin time method. Reference: Quick, A.J Bleeding Problems in Clinical Medicine. W.B. Saunders Company, Philadelphia.

One stage Prothrombin time method. Reference: Quick, A.J Bleeding Problems in Clinical Medicine. W.B. Saunders Company, Philadelphia. MANUAL PROTIME The Prothrombin time is a useful screening procedure for deficiencies in factors II, V, VII and X. Deficiencies in factor I, although rare, may also be detected. This test may be used to

More information

Coumadin Assisted Dosing - InPatients

Coumadin Assisted Dosing - InPatients MANUAL: PHARMACY POLICY AND PROCEDURE Page 1 of 6 SECTION: INCLUDES: MEDICATION USE, PRESCRIBING AND ORDERING Coumadin Assisted Dosing - InPatients Purpose: To provide guidelines to inpatient pharmacists

More information

Laboratory Monitoring of Warfarin Therapy. David Williams, M.D., Ph.D. Roger S. Riley, M.D., Ph.D. Ann Tidwell, M.T. (ASCP) SH

Laboratory Monitoring of Warfarin Therapy. David Williams, M.D., Ph.D. Roger S. Riley, M.D., Ph.D. Ann Tidwell, M.T. (ASCP) SH Laboratory Monitoring of Warfarin Therapy David Williams, M.D., Ph.D. Roger S. Riley, M.D., Ph.D. Ann Tidwell, M.T. (ASCP) SH Crystalline warfarin sodium (Coumadin, Panwarfin, Sofarin, Coufarin, Athrombin-K)

More information

COUMADIN ASSISTED DOSING - InPatients

COUMADIN ASSISTED DOSING - InPatients MANUAL: PHARMACY POLICY AND PROCEDURE Page 1 of 6 SECTION: INCLUDES: MEDICATION USE, PRESCRIBING AND ORDERING - InPatients Purpose: To provide guidelines to Wheaton Franciscan Healthcare Iowa inpatient

More information

Optimal Management in Patients with Oral-Anticoagulant. Anticoagulant

Optimal Management in Patients with Oral-Anticoagulant. Anticoagulant Optimal Management in Patients with Oral-Anticoagulant Anticoagulant Boonjong Saejueng, MD Cardiac Unit, Chest Disease Institute, Nonthaburi, Thailand Outlines ν Overview of mechanism of warfarin ν Monitoring

More information

Session 3 Topics. Argatroban. Argatroban. Drug Use and Adverse Effects. Laboratory Monitoring of Anticoagulant Therapy

Session 3 Topics. Argatroban. Argatroban. Drug Use and Adverse Effects. Laboratory Monitoring of Anticoagulant Therapy ~~Marshfield Labs Presents~~ Laboratory Monitoring of Anticoagulant Therapy Session 3 of 4 Michael J. Sanfelippo, M.S. Technical Director, Coagulation Services Session 3 Topics Direct Thrombin Inhibitors:

More information

VI.2 Elements for a Public Summary VI.2.1 Overview of Disease Epidemiology A combined deficiency of vitamin K-dependent clotting factors II, VII, IX,

VI.2 Elements for a Public Summary VI.2.1 Overview of Disease Epidemiology A combined deficiency of vitamin K-dependent clotting factors II, VII, IX, VI.2 Elements for a Public Summary VI.2.1 Overview of Disease Epidemiology A combined deficiency of vitamin K-dependent clotting factors II, VII, IX, and X (and proteins C, S, and Z) is usually caused

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Management of Oral Anticoagulant Therapy About this Presentation The content of these pages is from a presentation called "Management

More information

The Coagulation Cascade

The Coagulation Cascade The Coagulation Cascade Intrinsic Pathway: the contact activation pathway Triggered by the exposure of negative charge on collagen; High molecular weight kininogen, prekallikrein and factor XII all form

More information

Guideline for the Laboratory Monitoring of Oral Anticoagulation (Warfarin) CLP014 Revised September, 2008

Guideline for the Laboratory Monitoring of Oral Anticoagulation (Warfarin) CLP014 Revised September, 2008 Guideline for the Laboratory Monitoring of Oral Anticoagulation (Warfarin) CLP014 Revised September, 2008 Warfarin is the most commonly prescribed vitamin K antagonist in Canada. This Guideline is intended

More information

New anticoagulants: Monitoring or not Monitoring? Not Monitoring

New anticoagulants: Monitoring or not Monitoring? Not Monitoring The 2 nd World Congress on CONTROVERSIES IN HEMATOLOGY (COHEM) Barcelona, Spain September 6 8, 2012 New anticoagulants: Monitoring or not Monitoring? Not Monitoring Anna Falanga, MD Immunohematology and

More information

To provide an overview of the mechanism of action, dosing regimens, and side effects of warfarin and other vitamin K antagonists.

To provide an overview of the mechanism of action, dosing regimens, and side effects of warfarin and other vitamin K antagonists. WARFARIN OBJECTIVE: To provide an overview of the mechanism of action, dosing regimens, and side effects of warfarin and other vitamin K antagonists. BACKGROUND: Warfarin is an indirect anticoagulant producing

More information

Marcia L. Zucker, Ph.D. ZIVD LLC

Marcia L. Zucker, Ph.D. ZIVD LLC Marcia L. Zucker, Ph.D. ZIVD LLC 1 Explain the INR, what it is, how it is calculated and when it should be used Describe reasonable expectations for INR agreement across platforms Evaluate different INR

More information

Warfarin: A Comprehensive Review. Jay M Patel, PharmD

Warfarin: A Comprehensive Review. Jay M Patel, PharmD Warfarin: A Comprehensive Review Jay M Patel, PharmD Objectives Explain the important pharmacodynamic and pharmacokinetic properties of warfarin Describe the role of warfarin in the inpatient setting Identify

More information

POC INR Device Evaluation

POC INR Device Evaluation POC INR Device Evaluation Virginia POC Network August 14, 2012 Brad S. Karon, MD, PhD Associate Professor of Laboratory Medicine and Pathology Mayo Clinic Rochester, MN Financial: none Disclosures Off

More information

MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants

MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013 Anticoagulants Anticoagulants are agents that prevent the formation of blood clots. Before we can talk about

More information

REVIEW OF COAGULATION

REVIEW OF COAGULATION REVIEW OF COAGULATION Neil Harris MD Dept. of Pathology, Immunology and Laboratory Medicine University of Florida College of Medicine Gainesville, FL Presented by AACC and NACB LEARNING OBJECTIVES 1. Describe

More information

Worried about Warfarin?

Worried about Warfarin? Worried about Warfarin? Know the benefits of genetic testing. Iverson Warfarin Dosing Panel Warfarin Dosing Can Be a Challenge If you have patients who take warfarin (brand name Coumadin ), you know that

More information

Workshop 1: Warfarin initiation and maintenance. Rosalind Byrne 16/10/12

Workshop 1: Warfarin initiation and maintenance. Rosalind Byrne 16/10/12 Workshop 1: Warfarin initiation and maintenance Rosalind Byrne 16/10/12 Introduction Mechanism of action of warfarin Indications Initiation of anticoagulation for: Atrial fibrillation/flutter DVT/PE Maintenance

More information

Management of Oral Anticoagulation in the Era of Target-Specific Agents

Management of Oral Anticoagulation in the Era of Target-Specific Agents Mount Sinai Heart Nurse Practitioner Symposium November 21, 2014 Management of Oral Anticoagulation in the Era of Target-Specific Agents Elizabeth B. Rothlauf, MS, RN, NP-C Cardiovascular Institute The

More information

Pharmacotherapy in the Elderly. Judy MY Wong

Pharmacotherapy in the Elderly. Judy MY Wong Pharmacotherapy in the Elderly Judy MY Wong judywong@berkeley.edu Percentage of population with prescription and number of medication per individual increase with age Definitions Pharmacology: pharmakon

More information

Anticoagulant therapy

Anticoagulant therapy Anticoagulation: The risks Anticoagulant therapy 1990 2002: 600 incidents reported 120 resulted in death of patient 92 deaths related to warfarin usage 28 reports related to heparin usage Incidents in

More information

Warfarin. INR = PT of the patient x k (constant of

Warfarin. INR = PT of the patient x k (constant of Warfarin History Oral anticoagulants were discovered after a change in agricultural policy in North America in the 1920 s, which resulted in sweet clover being fed to cattle in place of corn. However,

More information

CHAPTER 19 Oral Anticoagulants

CHAPTER 19 Oral Anticoagulants CHAPTER 19 Oral Anticoagulants Introduction - Types - Mechanism of Action - Pharmacokinetics Monitoring of Oral Anticoagulant Therapy - Laboratory Monitoring - Preparations and Dosages - Management of

More information

B. Platelets 1. Myeloid tissue megakaryocytes thrombocytes (platelets)

B. Platelets 1. Myeloid tissue megakaryocytes thrombocytes (platelets) I. Hemostasis A. Define hemostasis vs. hemorrhage 1. Hemostasis 2. Hemorrhage B. Platelets 1. Myeloid tissue megakaryocytes thrombocytes (platelets) 2. Platelets are packed with chemicals a. Alpha granules

More information

Bleeding disorders or haemorrhagic diatheses are a group of disorders characterised by defective haemostasis with abnormal bleeding.

Bleeding disorders or haemorrhagic diatheses are a group of disorders characterised by defective haemostasis with abnormal bleeding. Bleeding disorders or haemorrhagic diatheses are a group of disorders characterised by defective haemostasis with abnormal bleeding. Bleeding may be spontaneous in the form of small haemorrhages into the

More information

Kevin Sponsel Pharm. D. Candidate 2013 Mercer University COPHS

Kevin Sponsel Pharm. D. Candidate 2013 Mercer University COPHS Warfarin Pharmacogenomics in the Elderly Kevin Sponsel Pharm. D. Candidate 2013 Mercer University COPHS Objectives! Consider clinical and genetic factors associated with warfarin dose requirements in the

More information

Mechanisms of common and important adverse drug reactions. Jack W. Strandhoy, Ph.D.

Mechanisms of common and important adverse drug reactions. Jack W. Strandhoy, Ph.D. Mechanisms of common and important adverse drug reactions Jack W. Strandhoy, Ph.D. Drug Safety Pharmacovigilance Paracelsus: All substances are poisons dose differentiates Toxicology adverse effects of

More information

Clinical Procedure: Anticoagulation Point-of-Care Test CoaguChek System Test

Clinical Procedure: Anticoagulation Point-of-Care Test CoaguChek System Test Clinical Procedure: Anticoagulation Point-of-Care Test Principle One method for monitoring the international normalized ratio (INR) is by using a capillary blood test as directed by the CoaguChek System

More information

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent

More information

Analytical Specifications RIVAROXABAN

Analytical Specifications RIVAROXABAN Page 1 of 9 ANALYTE NAME AND STRUCTURE - RIVAROXABAN SYNONYMS Xarelto CATEGORY Anticoagulant TEST CODE PURPOSE Therapeutic Drug Monitoring GENERAL RELEVANCY BACKGROUND Xarelto (rivaroxaban) is an orally

More information

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs

More information

ENZYMES. A protein with catalytic properties due to its power of specific activation Paul Billiet ODWS

ENZYMES. A protein with catalytic properties due to its power of specific activation Paul Billiet ODWS ENZYMES A protein with catalytic properties due to its power of specific activation 2007 Paul Billiet ODWS VITAMIN K LECTURE OBJECTIVES At the end of the lecture students should be able to : Define & classify

More information

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs

More information

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs

More information

Abnormal Basic Coagulation Testing Laboratory Testing Algorithms

Abnormal Basic Coagulation Testing Laboratory Testing Algorithms Global Coagulation Testing Abnormal Basic Coagulation Testing Laboratory Testing Algorithms Jeffrey S. Jhang, M.D. No single global laboratory test Bleeding history is the strongest predictor of bleeding

More information

STAGO PT / aptt / Fibrinogen General Procedure

STAGO PT / aptt / Fibrinogen General Procedure STAGO PT / aptt / Fibrinogen General Procedure Principle: The Stago Coagulation analyzer is an automated system used for in vitro testing of the coagulation system. For PT/aPTT/Fibrinogen, the Stago analyzer

More information

Thrombophilia. Steven R. Lentz, M.D. Ph.D. Carver College of Medicine The University of Iowa May 2003

Thrombophilia. Steven R. Lentz, M.D. Ph.D. Carver College of Medicine The University of Iowa May 2003 Thrombophilia Steven R. Lentz, M.D. Ph.D. Carver College of Medicine The University of Iowa May 2003 Thrombophilia Hereditary and acquired risk factors for thrombosis Venous thromboembolism Arterial thromboembolism

More information

DEEP VEIN THROMBOSIS (DVT): TREATMENT

DEEP VEIN THROMBOSIS (DVT): TREATMENT DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada

More information

Provided by the American Venous Forum: veinforum.org

Provided by the American Venous Forum: veinforum.org CHAPTER 3 CLOTTING DISORDERS Original authors: Edith A. Nutescu, Jessica B. Michaud, Joseph A. Caprini, Louis W. Biegler, and Robert R. McCormick Abstracted by Kellie R. Brown Introduction The normal balance

More information

DVT/PE Management with Rivaroxaban (Xarelto)

DVT/PE Management with Rivaroxaban (Xarelto) DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular

More information

Cytochrome P450 Effects of its metabolism on Drug Response, Interactions, and Adverse Effects. Mir Ali Sadat, M.D. October 2014

Cytochrome P450 Effects of its metabolism on Drug Response, Interactions, and Adverse Effects. Mir Ali Sadat, M.D. October 2014 Cytochrome P450 Effects of its metabolism on Drug Response, Interactions, and Adverse Effects Mir Ali Sadat, M.D. October 2014 Variance in drug response among persons of different ethnic origins depend

More information

Guidelines for the management of warfarin reversal in adults

Guidelines for the management of warfarin reversal in adults SharePoint Location Clinical Policies and Guidelines SharePoint Index Directory General Policies and Guidelines Sub Area Haematology and Transfusion Key words (for search purposes) Warfarin, Bleeding Central

More information

FAQs about Warfarin (brand name Coumadin )

FAQs about Warfarin (brand name Coumadin ) FAQs about Warfarin (brand name Coumadin ) What is warfarin? Warfarin is the most commonly used anticoagulant in the US. An anticoagulant is a drug used to prevent unwanted and harmful blood clots. Although

More information

Collection Guidelines for Routine & Special Coagulation Testing

Collection Guidelines for Routine & Special Coagulation Testing Revised May 2010 Collection Guidelines for Routine & Special Coagulation Testing Best samples come from peripheral stick with evacuated tube system 19 to 22 gauge needle (smaller or bigger could cause

More information

What Does Pregnancy Have to Do With Blood Clots in a Woman s Legs?

What Does Pregnancy Have to Do With Blood Clots in a Woman s Legs? Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning A Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning Drugs to Prevent Abnormal Blood

More information

Prescriber Guide. LIXIANA (edoxaban)

Prescriber Guide. LIXIANA (edoxaban) Prescriber Guide LIXIANA (edoxaban) OVERVIEW THIS GUIDE IS SPECIFICALLY FOR PRESCRIBERS IN RELATION TO THE USE OF LIXIANA (EDOXABAN). IT INCLUDES INFORMATION ON THE FOLLOWING: Indications Dosing recommendations

More information

Medication Use in the Elderly. Rebecca Beyth, MD, MSc Associate Professor, NF/SGVHS, and Dept of Aging and Geriatric UF College of Medicine 10/6/06

Medication Use in the Elderly. Rebecca Beyth, MD, MSc Associate Professor, NF/SGVHS, and Dept of Aging and Geriatric UF College of Medicine 10/6/06 Medication Use in the Elderly Rebecca Beyth, MD, MSc Associate Professor, NF/SGVHS, and Dept of Aging and Geriatric UF College of Medicine 10/6/06 Significance Persons > 65 years of age compose only about

More information

LECTURE 3. Coagulation Mechanisms HAEMATOLOGY BLOCK. DONE BY: Maha Adosary! REVISED BY: Shaimaa AlRefaie

LECTURE 3. Coagulation Mechanisms HAEMATOLOGY BLOCK. DONE BY: Maha Adosary! REVISED BY: Shaimaa AlRefaie LECTURE 3 Coagulation Mechanisms HAEMATOLOGY BLOCK DONE BY: Maha Adosary! REVISED BY: Shaimaa AlRefaie At the end of this lecture, student should be able to: Recognize the different clotting factors Understand

More information

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs

More information

Note: Page numbers in italics indicate figures. Page numbers followed by a t indicate tables.

Note: Page numbers in italics indicate figures. Page numbers followed by a t indicate tables. INDEX Note: Page numbers in italics indicate figures. Page numbers followed by a t indicate tables. Acquired bleeding disorders, 37-57 acquired combined inhibitor to factor V and thrombin, 55 acquired

More information

CLINICAL PRACTICE GUIDELINES. Initiation and Maintenance of Warfarin (Coumadin) In patients 10 kg

CLINICAL PRACTICE GUIDELINES. Initiation and Maintenance of Warfarin (Coumadin) In patients 10 kg Initiation and Maintenance of Warfarin (Coumadin) In s 10 kg General Information These guidelines apply to the use of warfarin for the treatment and prevention of thromboembolic disorders. Warfarin is

More information

Contents. Abstract... i. Committee Membership... iii. Foreword... vii. 1 Scope... 1. 2 Introduction... 1. 3 Standard Precautions...

Contents. Abstract... i. Committee Membership... iii. Foreword... vii. 1 Scope... 1. 2 Introduction... 1. 3 Standard Precautions... Vol. 28 No. 20 Replaces H47-A Vol. 16 No. 3 One-Stage Prothrombin Time (PT) Test and Activated Partial Thromboplastin Time (APTT) Test; Approved Guideline Second Edition This document provides guidelines

More information

Anticoagulation Therapy

Anticoagulation Therapy Annual Education 2014 HIGH-ALERT! HIGH-RISK! HIGH-ALERT! HIGH-RISK! HIGH-ALERT! HIGH-RISK! Institute of Safe Medication Practices (ISMP) Identified anticoagulants as "High Alert Medications Institute for

More information

Anticoagulation Essentials! Parenteral and Oral!

Anticoagulation Essentials! Parenteral and Oral! Anticoagulation Essentials! Parenteral and Oral! Anti-Xa and Anti-IIa! Parenteral Anticoagulants! Heparin family (indirect anti-xa and anti-iia):! UFH! LMWH (enoxaparin, fondaparinux)! Direct thrombin

More information

PLATELET COUNT MATERIALS PROCEDURE RESULTS

PLATELET COUNT MATERIALS PROCEDURE RESULTS Platelet count 5 PLATELET COUT hemocytometer, diluting pipette for white blood cells, diluting fluid (Dameshek's solution; cocaine chlorhydrate 3 g, sodium chloride 0.2 g, distilled water ad 00 ml), light

More information

CoaguChek XS Plus INR

CoaguChek XS Plus INR Page 1 of 7 CoaguChek XS Plus INR Edition No: 1.4 Author: Rosy Tirimacco / Paul Simpson Date: April, 2012 Operative Date: April, 2012 Review Date: January, 2013 Location: Country Health SA Integrated Cardiovascular

More information

Objectives. Understand the coagulation and thrombosis process. Explore the different anticoagulants treatments. available.

Objectives. Understand the coagulation and thrombosis process. Explore the different anticoagulants treatments. available. Assistant Professor of Molecular Toxicology College of Pharmacy, KSU hkorashy@ksu.edu.sa http://faculty.ksu.edu.sa/hkorashy Objectives Understand the coagulation and thrombosis process. Explore the different

More information

Vitamin K Supplementation with Oral Anticoagulation

Vitamin K Supplementation with Oral Anticoagulation Vitamin K Supplementation with Oral Anticoagulation Farhad Kamali Institute of Cellular Medicine, Newcastle University Vitamin K Vitamin K belongs to a group of fat-soluble 2-methyl-1,4- naphthoquinone

More information

The new oral anticoagulants & the future of haemostasis laboratory testing. Alcohol: the good, the bad and the ugly

The new oral anticoagulants & the future of haemostasis laboratory testing. Alcohol: the good, the bad and the ugly The new oral anticoagulants & the future of haemostasis laboratory testing Emmanuel J Favaloro Diagnostic Haemostasis Laboratory, Institute of Clinical Pathology & Medical Research, ICPMR, Pathology West,

More information

Drug interactions with warfarin. Drugs interact with warfarin: pharmacokinetics. Pharmacokinetic interactions. Drug interactions that increase the INR

Drug interactions with warfarin. Drugs interact with warfarin: pharmacokinetics. Pharmacokinetic interactions. Drug interactions that increase the INR Where possible avoid interacting drugs Monitor patients on interacting drugs Pharmacodynamic interactions Through changes affecting drug-receptor complex Increases risk of without increasing Pharmacokinetic

More information

DRUG INTERACTIONS. Mr.D.Raju M.Pharm., Lecturer

DRUG INTERACTIONS. Mr.D.Raju M.Pharm., Lecturer DRUG INTERACTIONS Mr.D.Raju M.Pharm., Lecturer Drug interactions Definition; It is the modification of the effect of one drug (the object drug ) by the prior concomitant administration of another (precipitant

More information

Warfarin: Optimising Time in Therapeutic Range (TTR)

Warfarin: Optimising Time in Therapeutic Range (TTR) Warfarin: Optimising Time in Therapeutic Range (TTR) Debra Rowett, Service Director, Drug and Therapeutics Information Service (DATIS) Thromboembolism is a major cause of morbidity and mortality worldwide.

More information

Anticoagulants. Anticoagulants Definition. When are blood clots GOOD? Where and why do blood clots occur? 6/12/2014

Anticoagulants. Anticoagulants Definition. When are blood clots GOOD? Where and why do blood clots occur? 6/12/2014 Anticoagulants Steven R. Kayser, PharmD Professor Emeritus Department of Clinical Pharmacy UCSF Anticoagulants Definition A substance that hinders the clotting of blood Sometimes referred to as blood thinners

More information

Dabigatran (Pradaxa) Guidelines

Dabigatran (Pradaxa) Guidelines Dabigatran (Pradaxa) Guidelines Dabigatran is a new anticoagulant for reducing the risk of stroke in patients with atrial fibrillation. Dabigatran is a direct thrombin inhibitor, similar to warfarin, without

More information

PATIENT INFORMATION LEAFLET OCTAPLAS. (Human Plasma)

PATIENT INFORMATION LEAFLET OCTAPLAS. (Human Plasma) page 1/5 PATIENT INFORMATION LEAFLET OCTAPLAS (Human Plasma) Please read this leaflet carefully before using this medicine. This leaflet provides a summary of the information important to the use of OCTAPLAS.

More information

Changing Coagulation Reagent Lots. BCSLS Congress 2011 Castlegar Kin Cheng

Changing Coagulation Reagent Lots. BCSLS Congress 2011 Castlegar Kin Cheng Changing Coagulation Reagent Lots BCSLS Congress 2011 Castlegar Kin Cheng Objective Revisit the coagulation model Describe the composition of PT and aptt reagents Describe the differences and limitations

More information

Easy Bruising and Bleeding in the Adult Patient: A Sign of Underlying Disease

Easy Bruising and Bleeding in the Adult Patient: A Sign of Underlying Disease Review of Clinical Signs Series Editor: Bernard M. Karnath, MD Easy Bruising and Bleeding in the Adult Patient: A Sign of Underlying Disease Bernard M. Karnath, MD Achief complaint of easy bruising and

More information

Anticoagulant Therapy. Dan Johnson, Pharm.D. September 8, 2016

Anticoagulant Therapy. Dan Johnson, Pharm.D. September 8, 2016 Anticoagulant Therapy Dan Johnson, Pharm.D. September 8, 2016 Disclosures No financial disclosures Off-label indications discussed Objectives Review pharmacology of anticoagulant agents commonly used in

More information

1. Baseline assessment prior to initiation of dabigatran (Pradaxa )

1. Baseline assessment prior to initiation of dabigatran (Pradaxa ) Dabigatran for stroke prevention in Atrial Fibrillation Clinical Guideline NICE TA249 published in March 2012 recommended dabigatran (Pradaxa ) as an option for the prevention of stroke and systemic embolism

More information

Drug Interactions. Sara Bogenschutz Angela Bojrab. Biology Of Aging Fall 2003

Drug Interactions. Sara Bogenschutz Angela Bojrab. Biology Of Aging Fall 2003 Drug Interactions Sara Bogenschutz Angela Bojrab Biology Of Aging Fall 2003 What is a Drug Interaction? A Drug interaction is an interaction between a drug and some other substance, such as another drug

More information

CLS (NCA), M.T. (ASCP)

CLS (NCA), M.T. (ASCP) The Why and How of: Reagent / QC Lot Roll-over Validation LabLink Interlab Reports Sandy Gardner B.S., M.T. (ASCP) Mary Ann Kozy Carol Shearer B.S., CLS (NCA), M.T. (ASCP) Dade Behring Hemostasis Application

More information

The Clotting Cascade and DIC. Karim Rafaat, MD

The Clotting Cascade and DIC. Karim Rafaat, MD The Clotting Cascade and DIC Karim Rafaat, MD Coagulation Coagulation is a host defense system that maintains the integrity of the high pressure closed circulatory system To prevent excessive blood loss

More information

Pantex. Pantoprazole. - Gastro esophageal reflux diseases - Treatment of ulcer resistant to H2-receptor antagonists

Pantex. Pantoprazole. - Gastro esophageal reflux diseases - Treatment of ulcer resistant to H2-receptor antagonists Pantex Only for the use of Medical Professionals Pantoprazole Prescribing information: Description Pantex is a preparation of Pantoprazole. Pantoprazole is a proton pump inhibitor, i.e. it inhibits specifically

More information

prevent its recurrence. The FDA is reviewing possible deficiencies in the manufacturer s reagent package labeling.

prevent its recurrence. The FDA is reviewing possible deficiencies in the manufacturer s reagent package labeling. science [coagulation and hematology] Laboratory Variables That May Affect Test Results in Prothrombin Times (PT)/International Normalized Ratios (INR) David L. McGlasson, MS, CLS/NCA, H, ASCP 59th Clinical

More information

Interesting Coagulation Cases. Nancy Rosenthal, MD University of Iowa Carver College of Medicine

Interesting Coagulation Cases. Nancy Rosenthal, MD University of Iowa Carver College of Medicine Interesting Coagulation Cases Nancy Rosenthal, MD University of Iowa Carver College of Medicine Objectives Describe complications of some anticoagulant drugs Assess the bleeding disorder associated with

More information

Anticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk

Anticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk Anticoagulation at the end of life Rhona Maclean Rhona.maclean@sth.nhs.uk Content Anticoagulant Therapies Indications for anticoagulation Venous thromboembolism (VTE) Atrial Fibrillation Mechnical Heart

More information

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016 Version 1.4 EQIA Yes 01/06/2012

More information

Genetics and Drug Response

Genetics and Drug Response Genetics and Drug Response Posted 12-1-04 Key Points Individual response to many drugs is highly variable. Genetic differences in drug-metabolizing enzymes and other genes associated with drug effects

More information

The coumarins or vitamin K antagonists (VKAs) have

The coumarins or vitamin K antagonists (VKAs) have The Pharmacology and Management of the Vitamin K Antagonists The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Jack Ansell, MD; Jack Hirsh, MD, FCCP; Leon Poller, MD; Henry Bussey,

More information

HEPARIN INDUCED THROMBOCYTOPENIA (HIT)

HEPARIN INDUCED THROMBOCYTOPENIA (HIT) HEPARIN INDUCED THROMBOCYTOPENIA (HIT) OBJECTIVE: To assist clinicians with the diagnosis and initial management of heparin induced thrombocytopenia (HIT) and suspected HIT. BACKGROUND: HIT is a transient,

More information

Anticoagulation in the Geriatric Patient: Detailed Issues in the Perioperative Period AGS

Anticoagulation in the Geriatric Patient: Detailed Issues in the Perioperative Period AGS Anticoagulation in the Geriatric Patient: Detailed Issues in the Perioperative Period AGS Susan M. Friedman, MD, MPH June 6, 2009 THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading

More information

Anticoagulants in Atrial Fibrillation

Anticoagulants in Atrial Fibrillation Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives

More information

LABFACTS 32. Plasma Prothrombin Time And The International Normalized Ratio (INR) 32-1

LABFACTS 32. Plasma Prothrombin Time And The International Normalized Ratio (INR) 32-1 Plasma Prothrombin Time And The International Normalized Ratio (INR) LABFACTS 32 This LabGuide discusses traditional plasma prothrombin time testing methods, not waived whole blood methods in popular use

More information

USE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN)

USE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) USE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals:

More information

CONTEMPORARY REVERSAL OF ANTICOAGULATION

CONTEMPORARY REVERSAL OF ANTICOAGULATION CONTEMPORARY REVERSAL OF ANTICOAGULATION Michael S. McHale, M.D., F.A.C.P. Avera Medical Group Hematology & Oncology Medications Coumadin / Warfarin Unfractionated Heparin Low Molecular Weight Heparin

More information

The Golden Rule of Specimen Collection: The Patient Test Result is Only as Good as the Sample We Get

The Golden Rule of Specimen Collection: The Patient Test Result is Only as Good as the Sample We Get The Golden Rule of Specimen Collection: The Patient Test Result is Only as Good as the Sample We Get Jan Frerichs, MLS (ASCP) The University of Iowa Janice-frerichs@uiowa.edu Importance of Phlebotomist

More information

Treatment of Bleeding in Dialysis Patient. Introduction. Normal Hemostasis. Primary hemostasis. Coagulation. Pathophisiology 2009/11/3

Treatment of Bleeding in Dialysis Patient. Introduction. Normal Hemostasis. Primary hemostasis. Coagulation. Pathophisiology 2009/11/3 Treatment of Bleeding in Dialysis Patient Miriam Galbusera,* Giuseppe Remuzzi,* and Paola Boccardo* Seminars in Dialysis Vol 22, No 3 (May June) 2009 pp. 279 286 Reporter: Clerk 陳律臻 Introduction Bleeding

More information

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs A Patient s Guide to Primary and Secondary Prevention of PATIENT EDUCATION GUIDE What Is Cardiovascular Disease? Cardiovascular disease (CVD) is a broad term that covers any disease of the heart and circulatory

More information

Pathophysiology of the Hemophilia A

Pathophysiology of the Hemophilia A Problem 5. Pathophysiology of the Hemophilia A In order to workout this problem study pages 32-5, 53, 555-6 and 556 of your Pathophysiology (5 th edition) textbook. A 22-year old medical student took a

More information

Lupus anticoagulant Pocket card

Lupus anticoagulant Pocket card Lupus anticoagulant Pocket card Issue number 5 2012 Antiphospholipid Syndrome 1 The antiphospholipid syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and /or pregnancy loss

More information

Coagulation - Simplified

Coagulation - Simplified Coagulation - Simplified Intrinsic Pathway Extrinsic Pathway Factor XII Factor IX TF/Factor VII fuel - amplification spark - initiation Factor X Factor II Common Pathway Fibrin clots Coagulation - Role

More information

Drug Interactions. Drug Antagonism. Terminology of Drug Interactions. Drug Absorption Interactions I. Introduction to Drug Interactions II

Drug Interactions. Drug Antagonism. Terminology of Drug Interactions. Drug Absorption Interactions I. Introduction to Drug Interactions II Drug Interactions Introduction to Drug Interactions I Dr. Robert G. Lamb Professor Pharmacology & Toxicology Drug interactions occur whenever the effect of a drug is modified by the presence of another

More information

NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS

NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS Date of First Issue 01/12/ 2012 Approved 15/11/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016

More information

Hemorrhage in Oral Surgery (Diagnosis & Management)

Hemorrhage in Oral Surgery (Diagnosis & Management) Hemorrhage in Oral Surgery (Diagnosis & Management) Types of Hemorrhage Arterial: Bright red, in jets with pulsation, profuse. Venous: Dark red in color and flows steadily and heavily. Capillary: Bright

More information

Disclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU

Disclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU New Agents for Treatment of DVT Disclosure PI Adopt and Amplify trials Mark Oliver, MD, RVT, RPVI,FSVU BMS and Pfizer Speaker VTE Venous Thromboembolism Recognized DVT s New : 170,000 Recurrent : 90,000

More information

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 06/06/2012 Review Date 06/06/2014 Version 1.1 EQIA Yes /

More information

Elements for a Public Summary

Elements for a Public Summary VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Gastro-oesophageal reflux disease (GERD), reflux oesophagitis: GERD is defined by the presence of symptoms resulting from abnormal

More information

1. NORMAL HAEMOSTASIS. Page 1. Haematology LECTURE 8. HAEMOSTASIS OVERVIEW. 1. Normal haemostasis. 2. Clinical signs of haemostatic disorders

1. NORMAL HAEMOSTASIS. Page 1. Haematology LECTURE 8. HAEMOSTASIS OVERVIEW. 1. Normal haemostasis. 2. Clinical signs of haemostatic disorders Undergraduate Course in Veterinary Clinical Pathology Socrates-Erasmus Programme Haematology LECTURE 8. HAEMOSTASIS 8-1 OVERVIEW 1. Normal haemostasis 2. Clinical signs of haemostatic disorders 3. Sample

More information

Speaker Disclosure. Outline. Pharmacist Objectives. Patient Case. Outline 9/4/2014

Speaker Disclosure. Outline. Pharmacist Objectives. Patient Case. Outline 9/4/2014 Speaker Disclosure Matthew K. Pitlick, Pharm.D., BCPS St. Louis College of Pharmacy/VA St. Louis HCS mpitlick@stlcop.edu Matthew K. Pitlick, Pharm.D., BCPS declares no conflicts of interest, real or apparent,

More information