Top 10 Thrombosis and Anticoagulation Highlights from ASH 2014
|
|
- Peregrine Woods
- 8 years ago
- Views:
Transcription
1 Top 10 Thrombosis and Anticoagulation Highlights from ASH 2014 Stephan Moll, MD UNC School of Medicine, Chapel Hill, NC 1. New Anticoagulant Factor XI lowering drug NEJM publication Dec 7 th (late- breaking abstract 1, Bueller H et al): A phase 2 study presented at ASH and published at the same time in the NEJM as a full paper showed that lowering of coagulation factor XI (with an anti- sense oligonucleotide drug) was effective in preventing post- operative DVT without increasing the risk of perioperative bleeding. The findings challenge the long- held belief that an anticoagulant automatically increases the risk for bleeding. May be it is possible that a drug works as an anticoagulant and prevents thrombosis, yet does not increase the risk for bleeding. Conclusion #1: Interesting early data. Of no clinical consequence at this point. 2. NOAC Antidotes Three main antidotes for the NOACs are in development and have recently been reviewed on Clot Connect ( ): Andexanet for the anti- Xa drugs (Xarelto, Eliquis ), Idarucizumab for Pradaxa, and Aripazine (PER977) as a more global reversal agent for all NOACs. No striking new data on these reversal agents were presented at ASH. a. Andexanet Abstract 4269 (Crowther M et al.): A Phase 2 Randomized, Double- Blind, Placebo- Controlled Trial Demonstrating Reversal of Edoxaban- Induced Anticoagulation in Healthy Subjects By Andexanet Alfa (PRT064445), a Universal Antidote for Factor Xa (fxa) Inhibitors. A phase 2 randomized, placebo- controlled trial that investigated reversal of the anti- Xa anticoagulant edoxaban in healthy subjects was presented at ASH. Andexanet rapidly reversed edoxaban s anticoagulant effect, as measured by coagulation tests. This study provides background efficacy and safety data on the use of Andexanet and is the prelude for the phase 3 clinical trial that is in the planning stages (not yet listed on clinicaltrials.gov) to use the drug in patients who present with major bleeding. b. Idarucizumab Abstract 344 (Glund S et al.): Idarucizumab, a Specific Antidote for Dabigatran: Immediate, Complete and Sustained Reversal of Dabigatran Induced Anticoagulation in Elderly and Renally Impaired Subjects. A phase 2 randomized, double- blind, placebo controlled study in healthy volunteers presented at ASH investigated the reversal of coagulation tests by intravenous idarucizumab and showed effective reversal. A phase 3 clinical trial in patients with major bleeding or who
2 need urgent reversal of dabigatran is ongoing (ClinicalTrials.gov Identifier: NCT ). c. PCC and apcc Abstract 345 (Perlstein I et al.): Reversal of Apixaban Anticoagulation By 4- Factor Prothrombin Complex Concentrates in Healthy Subjects. 15 healthy volunteers who took apixaban 10 mg bid received a 4 factor prothrombin complex concentrate (PCC). PCC reversed apixaban s anticoagulant effect as measured by several coagulation parameters (endogenous thrombin potential), suggesting that 4- factor PCCs (in the U.S.: Kcentra ) may be useful in the management of major bleeding in patients on apixaban. Abstract 4259 (Shaw J et al.): FEIBA for Patients on Direct Oral Anticoagulants Requiring Urgent Surgery. In a retrospective one- center chart review 5 patients on NOACs who required urgent reversal of anticoagulation for surgery were identified. All received FEIBA before surgery. The conclusion was that FEIBA was effective and not associated with adverse thrombotic complications. Conclusion #2: The development of several antidotes is promising. Non- activated and activated PCCs MAY be effective reversal agents for NOAC- associated major bleeding. A practical, clinical reversal strategy for the various anticoagulants and anti- platelet agents is presented on Clot Connect (link here: 3. Cancer and VTE a. VTE Treatment CATCH trial (Lee A et al.) Late- breaking abstract 2: A Randomized Trial of Long- Term Tinzaparin, a Low Molecular Weight Heparin (LMWH), Versus Warfarin for Treatment of Acute Venous Thromboembolism (VTE) in Cancer Patients - the CATCH Study ). In this open- label multicenter international study 900 patients with cancer and acute VTE were randomized into receiving either the low molecular weight heparin tinzaparin (Innohep ) for 6 months or LMWH for 5-10 days overlapping with warfarin to a target INR of 2-3. Symptomatic DVT was significantly less in the tinzaparin group compared to the warfarin group (2.7% vs 5.3%; HR 0.48;95% CI ). Major bleeding was the same in both groups, but non- major clinically relevant bleeding was less in the tinzaparin group (11% vs 16%). This study confirms what the CLOT study (dalteparin vs warfarin in patient with cancer and VTE) showed > 10 years ago: that LMWH is superior to warfarin in this patient population. However, it is noteworthy that (a) the warfarin failure rate in this current CATCH trial was much less than in the previous CLOT trial and (b) that the benefit of LMWH over warfarin was also much less pronounced in the current trial.
3 It needs to be seen how well the NOACs perform in cancer patients with VTE in comparison to warfarin and LMWH. A recent publication ( Direct Oral Anticoagulants in Patients with VTE and Cancer: A Systematic Review and Meta- Analysis ; Vedovati CM et al. Chest; epub Sept 11, 2014) of all the NOACs- in- VTE trials found that NOACs were at least as effective as warfarin in the patients enrolled into the trials who had cancer. However, it is important to point out that none of those trials were dedicated VTE- in- cancer trials. Two such cancer trials are noteworthy: (1) Young A et al. Anticoagulation therapy in selected cancer patients at risk of recurrence of VTE (Select- d trial): rivaroxaban vs. dalteparin; ongoing and enrolling. (2) Edoxaban vs. dalteparin (NCT NCT ) in the planning stages. Conclusion #3: LMWH is still the standard of care in cancer patients with acute VTE. However, if a patient cannot afford LMWH or objects to the s.c. injections, then either a NOAC or warfarin are both good and appropriate treatment choices. Education session Prevention and treatment of VTE in patients with cancer by Lee A [Hematology 2014; Education Program, ]. The talk and published article present existing guidelines on state- of the art prevention and treatment of VTE in patients with cancer; one of the author s conclusions is that the use of NOACs in patients with cancer is strongly discouraged due to (a) the lack of existing efficacy and safety data and (b) possible drug interactions of the NOACs with various chemotherapeutic agents. b. Unsuspected/incidental PE - Treatment Abstract 1546 (Bleker S et al.): Unsuspected PE in cancer patients: a multicenter, international, prospective, observational study. Clinically unsuspected PE is frequently diagnosed in cancer patients undergoing routine CTs for staging purposes or treatment response evaluation. Current guidelines suggest that such patients should receive similar initial and long- term anticoagulant treatment as for symptomatic PE. However, direct evidence is scarce. This ongoing trial will eventually give insight into the current treatment strategies in cancer patients with unsuspected PE and provide outcome data in respect to VTE recurrence, bleeding and mortality. Conclusion #4: Useful ongoing study. Of no clinical consequence at this point. Abstract 590 (van der Hulle T et al.): Risk of Recurrent Venous Thromboembolism and Major Bleeding in Cancer- Associated Incidental Pulmonary Embolism Amongst Treated and Untreated
4 Patients: A Pooled Analysis of 926 Patients. In this literature review, 926 cancer patients with incidental PE from 11 observational studies and ongoing registries were included. The key finding was that there was a 12% 6- month risk of symptomatic recurrent VTE in patients with cancer- associated incidental PE who did not receive anticoagulant treatment, which is more than double the risk of patients who were anticoagulated. These numbers support the judicious initiation of anticoagulant treatment in cancer- associated incidental PE. Conclusion #5: Patients with incidentally discovered PE may benefit from anticoagulation. c. IVC Filter Abstract 4247 (Cull EH et al.) Temporary vena cava filters in oncology patients. This is a prospective, single- institution registry of IVC filters in patients with active malignancy or receiving adjuvant therapy for a recent active malignancy. 179 filers were placed. The study showed that (a) 31 % of filters were placed without the patient having a contra- indication for anticoagulant therapy (which is the only clear- cut indication for filter placement), (b) 20 % or these filters were not removed, (c) the overall cost of filter placements and filter removals was over $2 million, i.e. an average of > $ 11,500 per IVC filter. Conclusion #6: IVC filters are commonly placed in patients with cancer and malignancy, at a significant $ cost. Clear indications for IVC filters placements are only: acute DVT and inability to anticoagulated. Other indications, such as (a) recurrent DVT in spite of therapeutic anticoagulation, (b) large DVT burden, and (c) limited cardio- pulmonary reserve are softer indications with a lack of evidence whether IVC filters are beneficial in this situation. As a side note: An interesting new IVC filter design is presently being studied (clincaltrials.gov, NCT ) in 135 patients, a bioconvertible IVC filter (Sentry filter images here: Following implantation a small bioabsorbable filament which holds the filter arms together at the apex of the filter cone begins to slowly degrade over a minimum of 60 days. Once the filament is dissolved, the filter arms are released, separating and retracting towards the IVC wall where they become endothelialized and incorporated into the IVC wall, leaving a patent lumen and unobstructed blood flow. d. Central venous catheter- associated DVT: Abstract 4260 (Delluc A et al.): Outcomes of central venous catheter associated upper extremity DVT in cancer patients.
5 In this retrospective one- center study 99 patients with upper extremity DVT associated with central venous catheter were treated with full- dose LMWH at first, then either intermediate dose, low- dose, or no LMWH. On full- dose LMWH no recurrent VTE occurred, but 2 major bleeding episodes. Conclusion #7: Given the heterogeneity of the population studied, no solid conclusions are possible, but the full manuscript will be interesting to see. Education session Central Venous Catheters by Geerts W [Hematology 2014; Education Program, ]. The talk and published article summarize that (a) symptomatic catheter- related DVT is treated with anticoagulation, typically without removing the catheter, and (b) the intensity and duration of anticoagulation depends on the extent of thrombosis, risk of bleeding, and need for continued use of the catheter; (c) the author presents two practical tables entitled My personal approach to the detection and management of catheter- related thrombosis and another one on the prevention. 4. TTP Treatment with a New Drug Abstract 229 (Peyvandi F et al.): Caplacizumab, anti- vwf nanobody potentially changing the treatment paradigm in TTP: results of the TITAN trial. An anti- von Willebrand factor (vwf) drug (nanobody; caplacizumab)) was used in patients with TTP in a clinical trial called TITAN. As the thrombotic complications of TTP are mediated by enhanced platelet binding to sub- endothelial collagen via overly active (high molecular weight) vwf, it makes sense to develop a drug for the treatment of TTP and the prevention of thrombosis, platelet activation and platelet destruction (i.e. thrombocytopenia) that inhibits vwf. 75 patients with acute TTP were treated either with caplacizumab or placebo added to daily plasma exchange (PLEX) in this randomized, placebo controlled, single- blind study. Patients treated with caplacizumab had more rapid achievement of platelet normalization and lower number of TTP exacerbations. Conclusion #8: Interesting. Of no clinical consequence at this point. 5. Unusual Clots a. Splanchnic vein thrombosis Abstract 592 (Ageno W et al.): Antithrombotic treatment and outcomes of splanchnic vein thrombosis in an international prospective registry: results of 2- year follow- up. In a multicenter international registry 604 consecutive patients with splanchnic vein thrombosis were enrolled and assessed for recurrent thrombosis, major bleeding and mortality over a 2 year follow- up period. 77 % of patients were on anticoagulants, 23 % not. The study found that (a) the risk for bleeding and recurrent
6 thrombosis depended on the etiology of the first thrombotic event (patients with liver cirrhosis had the highest bleeding and recurrent VTE rate), (b) major bleeding occurred in 3.8 %/year, recurrent thrombosis in 7.3%/year, i.e. not an unsubstantial risk for both. Conclusion #9: Limited data exist on best management of patients with splanchnic vein thrombosis. Individualized decisions need to be made based on (a) cause of the thrombotic event, (b) risk factors for recurrence, and (c) risk factors for bleeding. Abstract 4276 (Nicoletta R et al.): Safety of vitamin K antagonist treatment for splanchnic vein thrombosis: a multicenter retrospective cohort study. In this retrospective study 375 patients with splanchnic vein thrombosis were included. In 63 % of patients there was an explanation for the thrombosis (hematologic disease, liver cirrhosis, cancer, abdominal surgery, intra- abdominal inflammation or infection), 37 % were unexplained. 94 % of patients were treated with warfarin with a target INR of 2-3. Major bleeding occurred in 1.24 per 100 patient- years, recurrent thrombosis on treatment occurred in 1.37 per 100 patient- years. Presence of esophageal varices was a predictor of major bleeding. Conclusion #10: Oral anticoagulation is safe in many patients with splanchnic vein thrombosis; presence of esophageal varices leads to a higher risk for major bleeding. b. Ovarian vein thrombosis Abstract 587 (Assal A et al): Ovarian vein thrombosis: clinical features, risk factors, and outcomes. This is the largest ovarian vein thrombosis study to date: 223 cases of confirmed ovarian vein thrombosis over 10 years were retrospectively identified. (a) The majority occurred after abdominal surgery, particularly hysterectomy; (b) Right and left side were equally affected, 14 % were bilateral; (c) Anticoagulation was started in only 9.4 % of patients; (d) 11.7 % had a recurrent VTE, of which 20 were DVTs, 6 PEs; (e) 4/21 patients (19 %) who were on anticoagulation had a recurrent VTE. Conclusion #11: No clinical implications at this point. Many patients with ovarian vein thrombosis do not seem to need anticoagulation; others develop recurrent VTE in spite of anticoagulation. 6. DVT and PE Other Issues a. Abstract 591 (van der Hulle T et al): Recurrence Risk after Limited Duration of Anticoagulant Treatment for Late Second Venous Thromboembolism.
7 The fact that a patient has had 2 episodes of VTE does notnecessarily mean that the patient has be on long- term anticoagulation. The risk for a 3 rd VTE depends on whether the 2 nd thrombotic event was provoked or unprovoked: the former group of patients has a risk of recurrent VTE of 5.6 per 100 patient- years, the latter group on of 12 per 100 patient- years. Conclusion #12: Patients with a 2 nd episode of VTE do not necessarily need long- term anticoagulation, if the 2 nd clot was triggered by a transient risk factor. b. Educational talk by Moll S [Hematology 2014; Education Program, ]. The talk and article discuss in a clinical- practical manner VTE management issues from acute treatment to management of long- term complications, addressing new data gained in the last 2 years and putting them into a clinical context. Conclusion #13: This article addresses many of the treatment issues relevant for the acute and chronic management of VTE. 7. Thrombophilia Abstract 1544 (Schulman S et al): Influence of Thrombophilia on the Efficacy of Dabigatran Versus Warfarin for the Extended Treatment of Acute Venous Thromboembolism in RE- MEDY. A post- hoc subgroup analysis of the phase 3 dabigatran VTE trial (warfarin vs dabigatran for acute VTE) was done. The trial had not required thrombophilia testing, but in routine practice about 48% of patients had thrombophilia testing done. As expected the majority of thrombophilias detected were factor V Leiden and the prothrombin mutation, Protein C, S and AT deficiency and APLA antibodies were less common. The analysis found that patients with or without thrombophilia did equally well and treatment efficacy was not affected by the presence of thrombophilia. Conclusion #14: This analysis appropriately argues that the finding of a thrombophilia does not need to be a reason to deny a patient treatment with a NOAC. This is of clinical relevance. 8. Hematology and Reproduction Three detailed reviews on thrombophilia and thrombosis and women s health were presented and published. a. In vitro fertilization (Bates, SM; Hematology 2014, Education Program, : Anticoagulation and in vitro fertilization and ovarian stimulation). b. Pregnancy and VTE (Rodger M; Hematology 2014, Education Program, : Pregnancy and venous thromboembolism: TIPPS for risk stratification). c. Pregnancy complications (Middeldorp S; Hematology 2014, Education Program, : Anticoagulation in pregnancy complications).
8 Conclusion #15: These articles contain clinically helpful, evidence- based conclusions on best management of women at risk for or with established thrombosis and/or pregnancy complications. 9. Warfarin Management a. Bleeding Abstract 2867 (Morton CT et al): Initial Experience with 4- Factor PCC for the Reversal of Warfarin: Patterns of Use and Safety Outcomes. In this real world patient management situation, 33 patients at one institution were treated with 4- factor PCC (Kcentra for warfarin associated coagulopathy and the authors found Kcentra to (a) be effective in the rapid reversal of INR and (b) have a low complication rate, with only one patient developing a thrombotic phenomenon (acute coronary event) within 72 hours of administration of Kcentra. b. Low dose vit K Abstract 2872 (Crowther M et al): Low Dose Oral Vitamin K Does Not Increase Time in Therapeutic Range: Results of a Multicentre Clinical Trial. In this randomized 4- center trial 253 patients on warfarin were enrolled, to receive either 150 mcg of daily vitamin or placebo. 235 patients appropriate for analysis after a maximum of 9 months in the trial. The time- in- therapeutic INR range (TTR) increased in both the placebo and vitamin K group over the trial (from ca. 53.2%) to 65.6%, but the vitamin K patient group did not better than the placebo group. The authors appropriately conclude that in unselected patients on warfarin the addition of vitamin K does not lead to a better TTR. Conclusion #16: Vitamin K supplementation for all patients on warfarin is not indicated and not beneficial. However, previous studies have shown that it is beneficial in selected patients who have unstable INRs. 10. Choosing Wisely Campaign ASH continues its Choosing Wisely publications and this year again chose five Don't do topics in hematology; two of these deal with thrombosis and anticoagulation issues: a. Do not treat with an anticoagulant for > 3 months in a patient with a first VTE occurring in the setting of a major transient risk factor b. Do not test or treat for suspected HIT in patients with a low pre- test probability of HIT. Conclusion #17: Useful recommendation: In a patient with DVT or PE associated with a major transient risk factor, anticoagulation is only needed for 3 months.
Thrombosis and Hemostasis
Thrombosis and Hemostasis Wendy Lim, MD, MSc, FRCPC Associate Professor, Department of Medicine McMaster University, Hamilton, ON Overview To review the important developments in venous thromboembolism
More informationVenous Thromboembolic Treatment Guidelines
Venous Thromboembolic Treatment Guidelines About the NYU Venous Thromboembolic Center (VTEC) The center s mission is to deliver advanced screening, detection, care, and management services for patients
More informationNew Oral Anticoagulants. How safe are they outside the trials?
New Oral Anticoagulants How safe are they outside the trials? Objectives The need for anticoagulant therapy Indications for anticoagulation Traditional anticoagulant therapies Properties of new oral anticoagulants
More informationVenous Thromboembolism: Long Term Anticoagulation. Dan Johnson, Pharm.D.
Venous Thromboembolism: Long Term Anticoagulation Dan Johnson, Pharm.D. Disclosures No financial relationships with products discussed Off-label use of drug therapy always discussed Objectives Review clinical
More informationDVT/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 informationNew Oral Anticoagulants
New Oral Anticoagulants Tracy Minichiello, MD Associate Professor of Medicine Chief, San FranciscoVA Anticoagulation and Thrombosis Service Ansell, J. Hematology Copyright 2010 American Society of Hematology.
More informationDisclosure. 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 informationGruppo di lavoro: Malattie Tromboemboliche
Gruppo di lavoro: Malattie Tromboemboliche 2381 Soluble Recombinant Thrombomodulin Ameliorates Hematological Malignancy-Induced Disseminated Intravascular Coagulation More Promptly Than Conventional Anticoagulant
More informationAnticoagulation 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 informationThe Anticoagulated Patient A Hematologist s Perspective
The Anticoagulated Patient A Hematologist s Perspective Deborah M. Siegal MD MSc FRCPC Clinical Scholar Division of Hematology and Thromboembolism Thrombosis Canada Research Fellow McMaster University
More informationLow Molecular Weight Heparin. All Wales Medicines Strategy Group (AWMSG) Recommendations and advice
Low Molecular Weight Heparin All Wales Medicines Strategy Group (AWMSG) Recommendations and advice Starting Point Low Molecular Weight Heparin (LMWH): Inhibits factor Xa and factor IIa (thrombin) Small
More informationTo provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.
DEEP VEIN THROMBOSIS: TREATMENT TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.
More informationTraveller s Thrombosis. Dr. Peter Verhamme Vascular Medicine and Haemostasis UZ Leuven
Traveller s Thrombosis Dr. Peter Verhamme Vascular Medicine and Haemostasis UZ Leuven Case 1: To thromboprophylaxe or not Women, aged 49, BMI 29, Combined Oral Contraceptives. Family history of provoked
More informationWhat 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 informationDevang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical
Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Center A.Fib affects 2.2 million Americans. The lifetime
More informationNHS 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 informationTraditional anticoagulants
TEGH Family Practice Clinic Day April 4, 03 Use of Anticoagulants in 03: What s New (and What Isn t) Bill Geerts, MD, FRCPC Director, Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University
More informationNew Anticoagulants: When and Why Should I Use Them? Disclosures
Winship Cancer Institute of Emory University New Anticoagulants: When and Why Should I Use Them? Christine L. Kempton, MD, MSc Associate Professor of Pediatrics and Hematology and Medical Oncology Hemophilia
More informationComparison between New Oral Anticoagulants and Warfarin
Comparison between New Oral Anticoagulants and Warfarin Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. In recent years, several
More informationDec. 9, 2013, 11:00 a.m. EST
Dec. 9, 2013, 11:00 a.m. EST Portola Pharmaceuticals Announces New Phase 2 Results Confirming Immediate, Dose-Dependent and Well-Tolerated Reversal of Anticoagulation Activity of XARELTO(R) (rivaroxaban)
More informationNow We Got Bad Blood: New Anticoagulant Reversal
Now We Got Bad Blood: New Anticoagulant Reversal Kellie Rodriguez, PharmD, BCPS PGY2 Emergency Medicine Pharmacy Resident UF Health Jacksonville January 2016 Objectives 1. Review current treatment strategies
More informationDabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM
Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM This report was commissioned by the NIHR HTA Programme as project number 12/78
More informationNnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl
NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl Mikele Wissing, RN June 2014 Introduction until recently, was the unrivaled medication for treatment
More informationRivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Implementation of NICE TA 261 Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism Contents 1. Executive summary 2. Introduction
More information3/3/2015. Patrick Cobb, MD, FACP March 2015
Patrick Cobb, MD, FACP March 2015 I, Patrick Cobb, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict
More informationCritical Bleeding Reversal Protocol
Critical Bleeding Reversal Protocol Coagulopathy, either drug related or multifactorial, is a major contributing factor to bleeding related mortality in a variety of clinical settings. Standard therapy
More information2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS
ANTICOAGULATION UPDATE C AR R I E P AL M E R, D N P, RN, AN P - BC OBJECTIVES At the end of the presentation, the NP will be able to: Identify new indications for target-specific oral anticoagulants (TSOACs),
More informationPost-ISTH review: Thrombosis-I New Oral Anticoagulants 臺 大 醫 院 內 科 部 血 液 科 周 聖 傑 醫 師
Post-ISTH review: Thrombosis-I New Oral Anticoagulants 臺 大 醫 院 內 科 部 血 液 科 周 聖 傑 醫 師 The antithrombotic efficacy is limited but the risk of bleeding is indefinite Fuster V et al. Circulation 2011;123:e269-e367
More informationDisclosure. Warfarin
Disclosure No conflicts of interest to disclose Reversal Strategies for Novel Oral Anticoagulants Noelle de Leon, PharmD, BCPS Critical Care Pharmacist, Department of Pharmaceutical Services Assistant
More informationWarfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab
Warfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 28, 2015 2:30 pm I have no disclosures. Stroke risk reduction in
More informationMCHENRY 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 informationABOUT XARELTO CLINICAL STUDIES
ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the
More informationAPSR RESPIRATORY UPDATES
APSR RESPIRATORY UPDATES Volume 6, Issue 1 Newsletter Date: January 2014 APSR EDUCATION PUBLICATION Inside this issue: Venous thromboembolism Pulmonary embolism and deep vein thrombosis. 2 Outpatient versus
More information48 th Annual Meeting. Non-VKA Oral Anticoagulants: Prevention & Treatment of Bleeding. Terminology. Disclosure. Public Health Impact.
48 th Annual Meeting Terminology Non-VKA Oral Anticoagulants: Prevention & Treatment of Bleeding Stacy A. Voils, PharmD, MS, BCPS Navigating the Oceans of Opportunity Target-specific oral anticoagulants
More informationAnticoagulation and Reversal
Anticoagulation and Reversal John Howard, PharmD, BCPS Clinical Pharmacist Internal Medicine Affiliate Associate Clinical Professor South Carolina College of Pharmacy Disclosures I have no Financial, Industry,
More informationNational Guidance and New Protocols
National Guidance and New Protocols Dr Jane Strong Consultant Haematologist DVT clinical lead Acute VTE chair DAWN AC Twentieth User Group Meeting 8 th October 2012 Autumn dawn Restless geese take flight
More informationAnticoagulant Treatment for Deep Venous Thrombosis Direct Oral Anticoagulants (NOACs)
Anticoagulant Treatment for Deep Venous Thrombosis Direct Oral Anticoagulants (NOACs) Prof. P. HAINAUT Médecine Interne - Maladie Thromboembolique Cliniques Univ. Saint Luc - UCL Background Direct Oral
More informationNational Guidance and New Protocols
National Guidance and New Protocols Dr Jane Strong Consultant Haematologist DVT clinical lead Acute VTE chair DAWN AC Twentieth User Group Meeting 8 th October 2012 DVT patient pathway Assessment Diagnosis
More informationDirect oral anticoagulants in daily care: what do we know today and what are the remaining issues?
De afbeelding kan niet worden weergegeven. Mogelijk is er onvoldoende geheugen beschikbaar om de afbeelding te openen of is de afbeelding beschadigd. Start de computer opnieuw op en open het bestand opnieuw.
More informationNew Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis
New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET Departments of Gastroenterology and Hepatology,
More informationSpeaker 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 informationRecommendation for the Reversal of Novel Anticoagulants in Emergent Situations
Lauren Edwards PharmD Candidate 2016 Truman Medical Center, Lakewood Preceptor: Dr. Melissa Gabriel June 11, 2015 Recommendation for the Reversal of Novel Anticoagulants in Emergent Situations Background
More informationAnticoagulant 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 informationImplementation of NICE TAs 261 and 287
Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group Northampton General Hospital NHS Trust Northamptonshire Healthcare Foundation Trust Implementation
More informationRivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012
Rivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012 Agenda Ideal anticoagulant. Drawbacks of warfarin. Rivaroxaban in clinical trails. Present
More informationNew 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 informationPrescriber Guide. 20mg. 15mg. Simply Protecting More Patients. Simply Protecting More Patients
Prescriber Guide 20mg Simply Protecting More Patients 15mg Simply Protecting More Patients 1 Dear Doctor, This prescriber guide was produced by Bayer Israel in cooperation with the Ministry of Health as
More informationNew Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther
New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis Mark Crowther 1 Disclosures Advisory Boards in last 24 months Pfizer, Alexion, Bayer, CSL Behring,
More informationTime of Offset of Action The Trial
New Antithrombotic Agents DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant Amgen Tom DeLoughery, MD FACP FAWM Oregon Health and Sciences University What I am Talking About
More informationNovel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations
Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant
More informationCONTEMPORARY 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 informationNew Anticoagulation Options for Stroke Prevention in Atrial Fibrillation. Joy Wahawisan, Pharm.D., BCPS April 25, 2012
New Anticoagulation Options for Stroke Prevention in Atrial Fibrillation Joy Wahawisan, Pharm.D., BCPS April 25, 2012 Stroke in Atrial Fibrillation % Stroke 1991;22:983. Age Range (years) CHADS 2 Risk
More informationThe speakers have attested that their presentation will be free of all commercial bias toward a specific company and its products.
Update on New Anticoagulants (Apixaban, Dabigatran and Rivaroxaban) Patient Safety Daniel B. DiCola, MD and Paul Ament,, Pharm.D Excela Heath, Latrobe, PA Disclosures: Paul Ament discloses that he receives
More informationNew Anticoagulants: What to Use What to Avoid
New Anticoagulants: What to Use What to Avoid Bruce Davidson, MD, MPH Clinical Professor of Medicine Pulmonary and Critical Care Medicine Division University of Washington School of Medicine Seattle USA
More information23/06/2014. Implications for the Gastroenterologist. No financial interests I am not a hematologist
Implications for the Gastroenterologist Dr. Daniel Sadowski Royal Alexandra Hospital Edmonton, Ab. No financial interests I am not a hematologist 65 y.o. male referred for iron deficiency anemia (FIT positive)
More informationFailure or significant adverse effects to all of the alternatives: Eliquis and Xarelto
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics
More informationStop the Bleeding: Management of Drug-induced Coagulopathy. Stacy A. Voils, PharmD, BCPS Critical Care Specialist, Neurosurgery
Stop the Bleeding: Management of Drug-induced Coagulopathy Stacy A. Voils, PharmD, BCPS Critical Care Specialist, Neurosurgery Objectives Discuss contemporary management of warfarin reversal in patients
More informationNew Anticoagulants and GI bleeding
New Anticoagulants and GI bleeding DR DANNY MYERS MD FRCP(C) CLINICAL ASSISTANT PROFESSOR OF MEDICINE, UBC Conflicts of Interest None I am unbiased in the use of NOAC s vs Warfarin based on risk benefit
More informationOutpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013
Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013 General Principles: There is compelling data in the medical literature to support
More informationDOACs. What s in a name? or TSOACs. Blood Clot. Darra Cover, Pharm D. Clot Formation DOACs work here. Direct Oral AntiCoagulant
DOACs NOACs or TSOACs Generic Name DOACs Brand Name Mechanism of Action Direct Xa Inhibitor Direct Thrombin Inhibitor Dabigatran Pradaxa X Rivaroxaban Xarelto X Darra Cover, Pharm D Apixaban Eliquis X
More informationNovel Anticoagulation Agents DISCLOSURES. Objectives ATRIAL FIBRILLATION TRIALS. NOAC Comparison 6/12/2015
Novel Anticoagulation Agents DISCLOSURES James W. Haynes, MD Department of Family Medicine Univ of TN Health Science Center (Chattanooga) Objectives Understand mechanism of action behind the NOAC agents
More informationCardiology Update 2014
Cardiology Update 2014 Update on the Novel Oral Anticoagulants (NOACS) Raymond Kawasaki, MD AMG Cardiology December 6, 2014 Disclosures I have no disclosures relevant to this presentation Contents I. The
More informationNovel Oral Anti-coagulants in Patients with Malignancy Lori-Ann Linkins, MD, MSc(Clin Epi), FRCPC McMaster University, Hamilton, ON
Novel Oral Anti-coagulants in Patients with Malignancy Lori-Ann Linkins, MD, MSc(Clin Epi), FRCPC McMaster University, Hamilton, ON Disclosures Speaker honorarium from Bayer (rivaroxaban; Xarelto) and
More informationThrombophilia. 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 informationUSE 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 informationThe Role of the Newer Anticoagulants
The Role of the Newer Anticoagulants WARFARIN = Coumadin DAGIBATRAN = Pradaxa RIVAROXABAN = Xarelto APIXABAN = Eliquis INDICATION DABIGATRAN (Pradaxa) RIVAROXABAN (Xarelto) APIXABAN (Eliquis) Stroke prevention
More informationDisclosures. Objective (NRHS) Self Assessment #2
Development and Implementation of a Protocol for Reversing the Effects of Anticoagulants for Use in a Community Hospital Samantha Sepulveda, Pharm.D. PGY1 Pharmacy Resident Norman Regional Health System
More informationCommittee Approval Date: September 12, 2014 Next Review Date: September 2015
Medication Policy Manual Policy No: dru361 Topic: Pradaxa, dabigatran Date of Origin: September 12, 2014 Committee Approval Date: September 12, 2014 Next Review Date: September 2015 Effective Date: November
More informationReversal of Antiplatelet and Anticoagulant Therapy: What You Need To Know. Ronald Walsh, MD Chief Medical Officer Community Blood Services
Reversal of Antiplatelet and Anticoagulant Therapy: What You Need To Know Ronald Walsh, MD Chief Medical Officer Community Blood Services HEMOSTATIC PROCESS Initiation and formation of the platelet plug
More informationAdvanced Issues in Peri-Operative VTE Prevention
Advanced Issues in Peri-Operative VTE Prevention Michael-Anthony (M-A) Williams, M.D. Consultant Physician Centura Medical Consultants September 27th, 2012 Main Topics 1. The perils of the early mover-
More information5/21/2012. Perioperative Use Issues. On admission: During hospitalization:
Dabigatran and Rivaroxaban: Challenges in the Perioperative Setting Claudia Swenson, Pharm.D., CDE, BC-ADM, FASHP Central Washington Hospital Wenatchee, WA claudia.swenson@cwhs.com Dabigatran and Rivaroxaban:
More informationDISCLOSURES CONFLICT CATEGORY. No conflict of interest to disclose
DISCLOSURES CATEGORY Employment Research support Scientific advisory board Consultancy Speakers bureau Major stockholder Patents Honoraria Travel support Other CONFLICT No conflict of interest to disclose
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
More informationDisclosures. Overview. Anticoagulation in 2015: Where We Are and Where We Are Going. Impact of NOACs in Canada
Anticoagulation in 2015: Where We Are and Where We Are Going Jeffrey I Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis Heart & Stroke
More informationrivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC
rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC 13 January 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS
More informationDATE: 06 May 2013 CONTEXT AND POLICY ISSUES
TITLE: Low Molecular Weight Heparins versus New Oral Anticoagulants for Long-Term Thrombosis Prophylaxis and Long-Term Treatment of DVT and PE: A Review of the Clinical and Cost-Effectiveness DATE: 06
More informationAdherence to NOACs. Disclosure. Patricia van den Bemt EAHP Hamburg 2015
Adherence to NOACs Patricia van den Bemt EAHP Hamburg 2015 Disclosure Unrestricted research grants from Glaxo-SmithKline Boehringer Ingelheim Daiichi Sankyo Bayer Pfizer For research on medication safety
More informationConserva)ve Treatment of PE/ DVT
Conserva)ve Treatment of PE/ DVT Amir Kaki, MD FACC FSCAI Asst Prof of Medicine Wayne St SOM Medical Director Cardiac Catheteriza)on Lab Heart Hospital DMC Detroit, MI Incidence Acute pulmonary embolism
More informationDisclosure. Outline. Objectives. I have no actual or potential conflict of interest in relation to this presentation.
Disclosure I have no actual or potential conflict of interest in relation to this presentation. Sarah Lombardo, MD., MSc. General Surgery, University of Utah September 9, 2015 Objectives Outline Recognize
More informationAnticoagulation 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 informationThree new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
More informationPulmonary Embolism Treatment Update
UC SF Pulmonary Embolism Treatment Update Jeffrey Tabas, MD Professor UCSF School of Medicine Emergency Department San Francisco General Hospital sf g h Disclosure No Financial Relationships to Disclose
More informationReview of Non-VKA Oral AntiCoagulants (NOACs) and their use in Great Britain
Review of Non-VKA Oral AntiCoagulants (NOACs) and their use in Great Britain Dr Alexander (Ander) Cohen Guy s and St Thomas Hospitals, King s College London, UK Pavia Spring Meeting 13 June 2014 Overview
More informationPrevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) with one or more risk factors
News Release For use outside the US and UK only Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com Bayer s Xarelto Approved in the EU for the Prevention of Stroke in Patients
More informationXabans Good for What Ails Ya? Brian Tiffany, MD, PhD, FACEP Dept of Emergency Medicine Chandler Regional Medical Center Mercy Gilbert Medical Center
Xabans Good for What Ails Ya? Brian Tiffany, MD, PhD, FACEP Dept of Emergency Medicine Chandler Regional Medical Center Mercy Gilbert Medical Center DISCLOSURES No relevant financial disclosures I will
More informationAuthors: Partha Sardar MDa; Saurav Chatterjee MDb; Joydeep Ghosh MDc; Debabrata Mukherjee MD, MS d, Gregory Y H Lip MD, FRCP, FACC, FESCe.
Risk of Major Bleeding in Different Indications for New Oral Anticoagulants: Insights from a Meta- Analysis of Approved Dosages from 48 Randomized Trials Authors: Partha Sardar MDa; Saurav Chatterjee MDb;
More informationrivaroxaban 15mg and 20mg film-coated tablets (Xarelto ) SMC No. (852/13) Bayer plc
rivaroxaban 15mg and 20mg film-coated tablets (Xarelto ) SMC No. (852/13) Bayer plc 08 February 2013 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises
More informationThrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare
Thrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare Kenya Association of Physicians Conference 10 th May 2013 New anticoagulants:
More information4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71
Anticoagulation in the 21 st Century Adam Karpman, D.O. Saint Francis Medical Center/Oklahoma State University Medical Center Disclosures: None Atrial Fibrillation Most common arrhythmia in clinical practice.
More informationNHS FIFE WIDE POLICY - HAEMATOLOGY MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY
MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY The scope of this guideline is to simplify the management of patients on oral anticoagulation undergoing major and minor surgery.
More informationThe management of cerebral hemorrhagic complications during anticoagulant therapy
The management of cerebral hemorrhagic complications during anticoagulant therapy Maurizio Paciaroni Stroke Unit Division of Cardiovascular Medicine University of Perugia - Italy Perugia Stroke Registry
More informationAnalyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation
Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 29,
More informationSession 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 informationHome treatment of VTE
Home treatment of VTE Prof. Adel El-Etriby Ain-Shams University Venous Thromboembolism (VTE): The DVT and PE Continuum Migration Embolus Thrombus VTE refers to a continuum of disease that begins with DVT
More informationHow To Treat Aneuricaagulation
Speaker Introduction Jessica Wilhoite, PharmD, BCACP Doctor of Pharmacy: Purdue University Postgraduate Residency Training: PGY1 Pharmacy Practice St. Vincent Hospital PGY2 Ambulatory Care St. Vincent
More informationAcute behandeling van longembolie. Peter Verhamme. Bloedings- en Vaatziekten UZ Leuven. Research support and/or honoraria:
Acute behandeling van longembolie Peter Verhamme Bloedings- en Vaatziekten UZ Leuven Disclosures Research support and/or honoraria: Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Pfizer, BMS, Sanofi, Leo-pharma
More informationThe Brave New (Anticoagulant) World
The Brave New (Anticoagulant) World Diane M. Birnbaumer, M.D., FACEP Emeritus Professor of Medicine University of California, Los Angeles Senior Clinical Educator Department of Emergency Medicine Harbor-UCLA
More informationBreadth of indications matters One drug for multiple indications
Breadth of indications matters One drug for multiple indications Sylvia Haas, MD, PhD Formerly of the Technical University of Munich Munich, Germany Disclosures: Sylvia Haas 1 Novel oral anticoagulants:
More informationOut with the Old and in with the New? Target Specific Anticoagulants for Atrial Fibrillation
Out with the Old and in with the New? Target Specific Anticoagulants for Atrial Fibrillation Goal Statement Pharmacists and technicians will gain knowledge in the use of target specific oral anticoagulants
More information