World thrombosis day
Hope you all had an inspiring one on October 13. The online lecture by Jeff Weitz put out by the ISTH and emphasizing the significance of thrombosis among hospitalized patients was excellent, but I did not see much local publicity about this annual event. Perhaps THANZ needs a better publicist or was I watching the wrong channel?
Of course, 13/10 marks the birthday of Rudolph Virchow, widely regarded as the father of coagulation and modern pathology. It's always interesting to read about such pioneering supermen in more detail and find out that they weren't actually perfect or even always correct. In the case of Rudi, he considered Charles Darwin an "ignoramus". Later in life he went into politics and annoyed the German chancellor Bismarck so much that he was challenged to fight a duel. According to legend, having the right to choose weapons, he chose trichinella-infested pork sausages. Bismarck declined. However, thanks for the triad and for kicking things off in coag.
More strange stuff
Unfortunately, despite all the brilliant research, we still don't seem to know everything about haemostasis as exemplified by the failure of DOACs in certain circumstances.
THANZ have circulated a news release from the manufacturers of rivaroxaban, apixaban and dabigatran. They have aligned together in consultation with the TGA to release a New Safety Information letter which states that DOACs are "not recommended in patients with Anti-Phospholipid Syndrome due to possible increased risk of recurrent thrombotic events compared with warfarin". This is particularly for high risk APS patients ("triple" positive for LA, anti-cardiolipin antibodies and anti-beta 2 glycoprotein 1 antibodies). The advice is to review these high-risk patients if continued treatment is necessary and consider switching to an alternative therapy. Why aren't DOACs as good as warfarin for cardiac valves either?
Why is this so (as Julius Sumner-Miller used to say)? Why the "Treatment Failures of Direct Oral Anticoagulants" (Kajy M, Mathew A, Ramappa P. Am J Ther 2019, Oct 9. PMID 31599776)? Perhaps the "Living on Warfarin" cookbook mentioned in a previous newsletter may get into the best-seller list after all. Why did we have doubts?
More on LA
One of our special interests at Haematex is lupus anticoagulant. We have our CEPHEN range of ARTG listed APTT reagents with remarkably good LA sensitivity (made at Hyphen) and recently we have brought back our RUO Intrinsin APTT reagents (lupus sensitive and resistant).
We also have "ready for use" liquid stable dRVVT reagents (RUO) which are less affected by DOACs than the Stago or IL/Werfen ones.
We also have DOAC-Stop™, our DOAC-removing agent available and now qualified for use as an IVD. Use of this product allows clotting tests to be carried out on without interference from DOACs.
Perth Coag workshop
As usual, Haematex supported the THANZ workshop, this year it was on 19th October at the Perth Convention and Exhibition Centre. We displayed all the best from Hyphen Biomed and from our own R&D work at Haematex. Haematex has become an incubator for R&D in coagulation diagnostic methods for many years now with some of our developments in everyday lab use. Thanks to all those who came over to see what's new and in the pipeline.