Direct oral anticoagulants (DOACs), such as direct thrombin inhibitors and direct factor Xa inhibitors, are increasingly prescribed in various clinical scenarios for both adult and pediatric patients.  This has implications for the clinical laboratory, as DOACs may interfere with common coagulation tests.  Furthermore, though these medications do not require routine monitoring, clinicians often want to rule them out in patients presenting with life-threatening bleeding or requiring emergent procedures. This session will discuss laboratory approaches to measure DOACs and to manage their interference with coagulation testing.

Learning Objectives: 

• Compare and contrast the mechanism of action for DOACs versus other common anticoagulants, such as warfarin and heparin.
• Explain the impact of DOACs on common coagulation tests.
• Evaluate the utility of laboratory testing for DOACs in emergency settings.

Labroots is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E. ® Program. By attending this webinar, you can earn 1 Continuing Education credit once you have viewed the webinar in its entirety. CE credits are available for this webinar up to 1 years from the date of the live broadcast.

Clinical laboratories often interact their information technology (IT) department, especially when installing new instruments, adding new tests to the menu, defining critical values, analyzing ordering patterns, and developing clinical decision support (CDS) for test orders and results. Despite the need to work closely together, medical laboratory professionals may feel uncomfortable approaching IT, delaying potential improvements in laboratory workflows and patient care. We will provide information about how best the clinical laboratory can work with IT, along with examples where dialog has produced tangible, sustainable improvements across the larger healthcare setting.

 
Learning objectives:

• Present the role of informatics in modern clinical laboratories.
• Discuss importance of clinical laboratory relationships with the IT department to implement new tests and optimize CDS support.
• Provide examples of successful relationship building between clinical labs and IT department and the challenges involved.

Labroots is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E. ® Program. By attending this webinar, you can earn 1 Continuing Education credit once you have viewed the webinar in its entirety. CE credits are available for this webinar up to 1 years from the date of the live broadcast.

Hospital laboratories perform tests serving patients with many different underlying disease states, managed by different providers with different educational and training backgrounds. As such, medical laboratory professionals may be called on to provide information to providers about how a test works, potential interfering substances, best practices for sample collection, and other details. In this webinar, we will discuss different areas related to coagulation testing which providers outside the lab may need help to fully understand, including anti-Xa for anticoagulant monitoring, D-dimer for thrombosis exclusion, and heparin-induced thrombocytopenia (HIT) screening.

 Learning Objectives

• Present common sample collection and potential interference issues for coagulation testing 
• Demonstrate best practices for sample collection to avoid common problems
• Define alternate and less common tests that can be hugely helpful for patient care across care networks

Labroots is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E. ® Program. By attending this webinar, you can earn 1 Continuing Education credit once you have viewed the webinar in its entirety. CE credits are available for this webinar up to 1 years from the date of the live broadcast.

Laboratories are required to participate in proficiency testing (PT). PT is a powerful tool for laboratories to learn about their own testing performance and discover potential issues with testing methods. This sessions will review basic information on PT testing performance, regulations, classification of analytes, and analysis of results. Examples will be presented to show how proficiency testing has identified limitations with laboratory testing.

Learning Objectives: 

• Describe regulations related to proficiency testing, including regulated and graded analytes.
• Discuss aspects to consider when reviewing proficiency testing results.
• Illustrate examples were proficiency testing has identified issues with laboratory testing.

Labroots is approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E. ® Program. By attending this webinar, you can earn 1 Continuing Education credit once you have viewed the webinar in its entirety. CE credits are available for this webinar up to 2 years from the date of the live broadcast.

Internal quality control is an integral process of laboratory testing. A clinical laboratory's coagulation quality control (QC) program is a critical component of its quality assessment program. The purpose of quality control in the laboratory is to detect, decrease, investigate, and help resolve deficiencies in a laboratory's internal analytical process prior to the release of patient results, to improve quality of the results reported. Analytical variables such as inappropriate reagent or instrument calibrations, inaccurately reconstituted reagents, and instrument-related instabilities can have a serious impact on testing and patient care. A key to reliable patient results and consistent laboratory processes is through understanding of laboratory performance assessment, how to practically troubleshoot QC, and how to apply a logical troubleshooting approach in coagulation. This presentation delves into the intricacies of maintaining and enhancing the quality control processes in coagulation assays.

Learning Objectives:

1. Describe the purpose of quality control procedures in coagulation, including its role in monitoring testing processes, error detection, and problem correction to ensure accurate and reliable test results

2. Explain the benefits of internal quality control (IQC) and external quality assurance (EQA) in ensuring the accuracy and reliability of coagulation test results

3. Evaluate scientific recommendations regarding analytical quality in coagulation testing

4. Design and implement quality improvement measures within the coagulation laboratory

• Present an overview of coagulation factors, highlighting the role of low factor levels in hemophilia and related disorders.
• Compare clotting vs. chromogenic factor assay methods.
• Highlight case studies featuring the role of coagulation factor assays in the clinical setting.

• Describe common scenarios resulting in heparin resistance observed in clinical settings
• Demonstrate clinical management approaches for patients exhibiting heparin resistance, including the role of anti-Xa testing
• Illustrate the impact of discordance between anti-Xa vs. aPTT and activated clotting time (ACT) in patients exhibiting heparin resistance
• Provide case studies illustrating clinical management and impact on potential heparin resistant patient testing

• Distinguish between routine and specialized coagulation testing
• Discuss the cause of the declining number of laboratories offering specialized coagulation testing
• Describe the clinical utility of specialized coagulation testing
• Illustrate the clinical impact of having specialized coagulation testing in-house through case studies

• Describe the role of antibodies against PF4/heparin complexes in pathogenesis of HIT
• Learn the clinical and laboratory criteria for screening and diagnosis of HIT
• Describe the advantages and potential pitfalls of various laboratory tests for diagnosis of HIT
• Understand the diagnosis and management algorithm for HIT in routine practice

• Present challenges surrounding the diagnosis of venous thromboembolism during pregnancy
• Review recent evidence on the use of D-dimer in pregnant women with suspected VTE
• Discuss how to integrate most recent evidence in clinical practice

             

• Describe the unique challenges transitioning a patient from a direct oral anticoagulant to a heparin infusion
• Compare and contrast heparin anti-Xa assay levels to aPTT to manage heparin infusions
• Evaluate recent literature developments on how to manage DOAC to heparin transitions
• Present a patient on a DOAC transitioning to heparin, appropriately interpret laboratory values to appropriately manage the transition

• Identify relevant pre-analytical variables that can impact coagulation results
• Provide solutions to minimize pre-analytical errors
• Enhance problem solving skills

                                                           

• Describe viscoelastic testing and its key challenges as part of a patient-centered bleeding management protocol
• Identify how the implementation of technology, design and process driven advances can support patient-centered needs, without sacrificing laboratory requirements
• Interpret and explain the results of a new viscoelastic test platform, using real-world case examples from a recent implementation

                                                           

                        

• Describe differences between unfractionated heparin (UFH), low-molecular-weight-heparin (LMWH) and direct-oral anticoagulants (DOACs) and impact on laboratory monitoring
• Identify advantages and disadvantages of surrogate markers to monitor and measure efficacy of UFH LMWH and DOACs, focusing on reference ranges and limitations of the traditional surrogate markers and benefit of anti-Xa monitoring
• Present management strategies for appropriate use of anti-Xa heparin level determinations
• Highlight case studies featuring situations for which direct oral anticoagulant measurement assisted with patient management

• Summarize the recent American Society of Hematology (ASH) guideline
• Update the ongoing data based changes in recommendations based on ACTIV studies
• Discuss relevance to coagulation laboratory based testing practices and clinical relevance
• Offer some clinical perspectives from managing hemostatic dysfunction in COVID-19 and using laboratory testing for optimal management

• Understand the new role of elevated D-dimer as a predictor of venous thromboembolic (VTE) risk in hospitalized medically ill patients
• Assess novel data about elevated D-dimers in predicting poor outcomes and risk of thrombosis in hospitalized COVID-19 patients
• Review the incorporation of D-dimer in novel VTE risk scores
• Understand how elevated D-dimers can be used to identify patients with a net clinical benefit of extended thromboprophylaxis post hospital discharge

To provide a discussion of the thromboembolism risk of COVID-19 and how risk factors relate to laboratory medicine results, the presentation will include case based discussions on how different laboratory values can aid in identifying those at risk of thromboembolic complications.  Further, for patients requiring therapeutic heparin infusions for active thromboembolism treatment, optimal monitoring strategies will be covered, along with the possible need for post discharge prophylaxis.

Learning objectives:

• Describe what is currently known about the etiology and proposed pathophysiology of thromboembolism in COVID-19
• Identify laboratory parameters that may help identify patients at risk of thromboembolic complications in COVID-19
• When presented with a COVID-19 case, choose an appropriate thromboembolic prevention strategy
• When presented with a COVID-19 case with a likely or confirmed thromboembolism, choose an appropriate thromboembolic treatment strategy

The International Council for Standardization in Haematology (ICSH) is a nonprofit organization dedicated to providing open-access guidance documents to enhance the quality of laboratory testing and practice.  A recently published ICSH initiative centered on providing laboratory guidance to 1) identify all coagulation tests with potential patient risk based on test methodology, test result, and patient presentations, 2) recommend critical result thresholds; 3) provide acceptable reporting and documenting mechanisms, and 4) delineate the required elements for  laboratory policies.  Theis presentation will describe the rationale for critical values/tests recommendations by renowned opinion leaders in the field of laboratory coagulation.

At the conclusion of this webinar attendees will be able to:
1) understand and define the difference between a critical value and a critical test,
2) describe the recommended coagulation tests with associated with critical values,
3) identify the recommended elements for reporting and documenting critical values, and
4) apply the recommended requirements for a critical value/test laboratory policy

This talk will cover different approaches to emergency hemostasis testing for patients that are actively bleeding due to trauma, surgery, obstetrical emergencies and other causes. The talk includes a discussion of rapid testing in the clinical laboratory, satellite laboratories and point of care testing using standard coagulation assays (prothrombin time, fibrinogen, platelet count and hematocrit) versus viscoelastic methodology. Critical aspects of emergency versus routine testing are reviewed and platelet function assays useful in rapid assessment of bleeding patients are discussed.

Learning Objectives

1. Describe the different types of coagulation assays used for emergency testing
2. Understand critical differences between routine and emergency testing
3. Understand role of platelet function testing

The compendium of newly emerging and currently available hemophilia and anticoagulant treatments, while offering new choices for improved patient care, can create significant levels of interference with routine and specialized laboratory coagulation assays. Our new educational session will examine the interference in coagulation tests from presence of the direct oral anticoagulants (DOACs) and the extended half-life (EHL) and non-factor products. It is important for laboratories to be aware of how both classes of these products, when present, can impact downstream results and clinical decision making.  

Upon completion of this session, participants will be able to:
1. Identify how to detect DOAC’s with routine coagulation tests and how they impact results.
2. Understand how the new EHL products for hemophilia A and B perform in relation to the laboratory’s coagulation reagents.
3. Increase awareness of the impact of these issues on coagulation testing.

Standardization and harmonization of coagulation testing methods have come a long way in the last 3 to 4 decades; however, standardization is imperfect.  Laboratory professionals need to recognize the limitations of some of our most commonly used coagulation tests.  The INR system has harmonized prothrombin time across methods and platforms for the purpose of monitoring warfarin, but the system does not harmonize very high INR values nor does it harmonize INR values in the setting of liver disease.  Many hospital-based laboratories perform a one stage factor VIII assay to support a wide range of clinical indications.  In the last decade, important biases have been demonstrated between one stage assays and chromogenic assays when diagnosing hemophilia A patients or monitoring new hemophilia therapies.  Finally, quantitative D-dimer assays have excellent negative predictive value to exclude venous thromboembolism.  Unfortunately, there is a lack of standardization, and even a lack of a standardized unit of measure.  Implementation of D-dimer requires careful attention to both the unit of magnitude and the unit type, especially when using different instrumentation across a laboratory system.

Learning Objectives:

• Recognize limitations of INR system
• Choose appropriate factor VIII and factor IX assays for various clinical indications
• Identify potential safety issues created by nonuniform D-dimer units and lack of standardization

D-dimer is used in the clinical evaluation of suspected venous thromboembolism (VTE). Newer measurement methods show high sensitivity for this test, and in combination with pretest probability assessment, have a high negative predictive value for exclusion of VTE, obviating the need for many imaging procedures, optimizing healthcare resource utilization. This presentation will highlight the evidence supporting the clinical utility of D-dimer in VTE: upper extremity, lower extremity, recurrent lower extremity DVT and pulmonary embolism. The American Society of Hematology 2018 updated clinical practice guidelines outlining an evidence-based strategy for the diagnostic evaluation of VTE will be reviewed.

Learning Objectives: 

• Review the measurement of D-dimer and sensitivity/specificity for the clinical evaluation of suspected venous thromboembolism.
• Describe the clinical utility of D-dimer in the diagnostic management of suspected upper extremity, lower extremity deep vein thrombosis, recurrent deep vein thrombosis and pulmonary embolism.
• Review the American Society of Hematology practice guidelines 2018 for the Diagnosis of Venous Thromboembolism.

Case studies to practice problem solving in the coagulation laboratory will be presented during this webinar. It will review pre-analytical issues impacting results as well as testing patterns that can be both cost effective while optimizing patient outcomes. Coagulation disorders and dedicated assays can be complex for newcomers and the best results are obtained when testing is approached in a logical, step by step manner. Understanding the importance of accurate screening results in the diagnosis and management of patients will only improve the information the laboratory provides to clinicians.

Learning objectives:

•  Identify proper testing to aid in the diagnosis of bleeding or clotting disorders
•  Perform best coagulation practices to help maximize negative outcomes while minimizing costs
•  Enhance problem solving skills by presentation of applicable case studies

Have you ever wondered about the impact of direct oral anticoagulants (DOACs) on routine coagulation assays and how patients on DOACs can be managed by the clinical laboratory? DOACs have been available for several years to treat atrial fibrillation patients at risk of stroke, as well as patients with venous thromboembolism (VTE). Though routine monitoring is not required for patients taking DOACs, screening or measurement assays could help in some emergency patient management situations. Dr Crowther’s webinar will cover this hot topic, which regularly impacts patients in critical care settings.

Learning objectives:

• Highlight recent clinical trials describing use of DOACs
• Present situations for which DOAC monitoring can help in the picture of patient care
• Review best practice with respect to DOAC measurement

Coagulation testing is commonly performed in hospital systems to screen for potential bleeding or thrombotic disorders. Examples of patient populations and clinical applications include outpatients presenting to the emergency room with signs of venous thromboembolism (VTE), perioperative screening to exclude the potential for bleeding during surgery, or to monitor inpatient anticoagulant treatment. Newly acquired coagulation testing instruments require an extensive validation process before being used for live patient testing in order to ensure quality of test results. Instrument validation can be especially challenging for different hospitals within a health network, due to different testing menus, volumes, and instruments used in these centers. The webinar will provide guidance on how coagulation testing instruments are validated, test results verified, and ensuring continuous quality during the life of the instruments.

Learning objectives:

• Describe the responsibility of the laboratory during the validation process of new instrumentation 
• Distinguish between validation and verification of laboratory instrumentation
• Present strategies for ensuring continuous quality of laboratory testing results on a daily basis, focusing on hemostasis testing

Laboratory testing for coagulation factor deficiencies and inhibitors is important for diagnosing and monitoring inherited and acquired coagulopathies and for evaluating the causes of coagulation screening test abnormalities. The webinar will cover strategies and pitfalls to consider and which assays should be performed to further evaluate test abnormalities, including assays for specific factor inhibitors. Real life cases, and illustrations of pre-analytical errors and interferences, will be used to illustrate important practice points. The different patterns and causes of abnormalities will be reviewed to ensure that laboratories consider all potential causes of abnormal findings.

Participants in this session will be able to:

• Differentiate which factor deficiencies are common and which are rare
• Describe what factor assays should be considered for a preoperative patient with a prolonged APTT, and which abnormalities are most common
• Describe how to test for a coagulation factor deficiency and a specific factor inhibitor
• Describe at least two pre-analytical errors that could cause test abnormalities that mimic a factor deficiency

 P.A.C.E. ® Credits are no longer available for this webinar.

This session will look at the common issues that can impact quality in the coagulation laboratory and result outcomes.  Implementing a good quality management system and being able to conduct a root cause analysis can not only solve problems, but can help to establish protocols that will prevent them in the future. Information will be presented in a case study format to highlight real-life case scenarios and how laboratories can handle and prevent future issues to ensure they can optimize their coagulation testing and patient care.

Objectives:

• Identify solutions in areas of coagulation that can be enhanced by implementing good laboratory practices and standard operating procedures
• Analyze real-life case studies and how to troubleshoot testing to determine root cause and steps to prevent reoccurrence.
• Enhance general knowledge of coagulation standards and methods

 P.A.C.E. ® Credits are no longer available for this webinar.

When patients taking direct oral anticoagulants (DOAC's) are admitted to the hospital, there may be a need for bridging parental anticoagulation especially for those at high risk of thrombosis recurrence.  By presenting information on DOAC interference in laboratory assays, institutional experiance, and case studies, this webinar will address questions surrounding management of patients on DOAC therapy.

Objectives:

• Identify the effects of direct oral anticoagulants on common  and other anticoagulation laboratory measures
• Describe common errors that are seen in practice when the effect of DOACs on common anticoagulation laboratory measures is not realized
• When presented with challenging cases, show how traditional and other laboratory measures can help guide safe, appropriate therapy

 P.A.C.E. ® Credits are no longer available for this webinar.

This webinar will look at the principles of the assays available to monitor heparin.  The most frequent assay that is used is the activated partial thromboplastin time (aPTT).  This assay is readily available and inexpensive.  However aPTT reagents are poorly standardized and have different sensitivities to heparin. There is no dose response relationship with heparin.  Due to the analytical and biological variables of heparin, patients respond to it differently.  Laboratories using the aPTT to monitor heparin, need to provide clinicians with a heparin therapeutic range specific for their lot of reagent on their analyzer.  An anti-Xa assay is a standardized test that has good precision, and is linear. A heparin assay can provide clinicians with an assay that accurately determines heparin levels and can improve overall patient heparin management.

The objectives of this webinar are:

• Describe the principle of the aPTT and  heparin assays
• Identify the advantages of each assay and outcomes for patient care
• Enhance problem solving skills by analyzing data from case studies.

Lupus anticoagulants are markers of prothrombotic potential which may be indicative of underlying antiphospholipid syndrome (aPS) requiring treatment with ongoing anticoagulants.  The purpose of this educational program is to update healthcare professionals regarding advancements in Lupus Anticoagulant (LA) testing. Current LA diagnostic guidelines, clinical evidence regarding LA significance, assay selection, and anticoagulant drugs interfering with LA testing will be discussed, along with clinical cases of high interest.

• Describe role of Lupus Anticoagulant (LA) in Antiphospholipid Syndrome (APS).
• Define current ISTH and CLSI Guidelines, identify tests, and define patient selection for appropriate LA work up.
• Recognize medications that may cause false positive LA results.
• Evaluate the right testing strategy for LA testing.
• Correlate LA and APS to specific clinical cases.

P.A.C.E. ® Credits are no longer available for this webinar.