Recommendation for the Reversal of Novel Anticoagulants in Emergent Situations

Size: px
Start display at page:

Download "Recommendation for the Reversal of Novel Anticoagulants in Emergent Situations"

Transcription

1 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 Within the last several years, new anticoagulant medications have been used to treat patients with thromboembolic disorders and risk factors for an adverse bleeding event. These agents are preferred by many physicians because of their minimal food and drug interactions; thereby requiring less frequent monitoring and dosing fluctuations in comparison to Warfarin (Coumadin) [1]. Dabigatran (Pradaxa) is a direct thrombin inhibitor that can be taken orally. By acting directly on thrombin, it can prevent clot development with either clot-bound thrombin or thrombin-induced platelet aggregation [2]. There is no recommended dosing regimen in patients with a creatinine clearance less than 30 ml/minute or in dialysis patients, and no other monitoring parameters need to be measured with this medication. Rivaroxaban (Xarelto) and Apixiban (Eliquis) are direct factor Xa inhibitors. These agents are becoming increasingly more popular in prophylaxis of patients undergoing major orthopedic surgery (especially hip and knee) [3]. Both agents have to be used cautiously in low kidney function as well as with other agents that act on similar receptors [2] but require no additional monitoring. According to the 2012 CHEST guidelines, these new anticoagulants should be anticipated to be used for an extended period of time. In patients with a provoked venous thromboembolic episode, these agents can be used for up to three months, and in an

2 unprovoked incident the length is extended. If a second episode occurs, regardless of the source, anticoagulants will in all probability be used for life [3]. With older agents such as Warfarin (Coumadin) and Enoxaparin (Lovenox), a reversal agent can be used in emergency cases where there is a major bleed. Because of the novelty of the factor Xa and direct thrombin inhibitors, no reversal agent has been developed and approved. There are currently three agents in clinical development that are designed to reverse these anticlotting agents, but it could take many years before they are available for use. Idarucizumab is a fragmented antibody that is being investigated to reverse dabigatran (Pradaxa); adexanet alfa is designed to bind to and reverse the anticoagulant properties of factor Xa; and aripazine is an artificial agent that was created to reverse all novel anticoagulants as well as fondaparinux and low molecular weight heparin [4]. [4] [4]

3 Study Analysis It is challenging to find suitable agents for reversing specific situations because of the limited amount of data and studies performed. Many of these studies examined use in animals, ex-vivo, or in-vivo in healthy volunteers. This makes it impossible to know how these reversal agents would work in a human patient with an active bleed. The tests looking at human data also employ coagulation tests, which reflect outcomes that cannot represent efficacy in the context of bleeding [5]. A recent study conducted at the Academic Medical Center in Amsterdam, the Netherlands looked at 12 healthy male subjects. They were randomized in a double-blind, placebo-controlled, crossover trial. The participants received a standard dose of either rivaroxaban or dabigatran for three days before being admitted to the hospital to be infused with either PCC (Cofact) or a saline placebo. A blood sample was collected 24 hours after this infusion. After a washout period of 11 days, the participants switched to the other anticoagulant medication for three days, and were given PCC (Cofact) or a saline infusion in the hospital on the third day of treatment. A second blood sample was collected 24 hours after this infusion. The study analyzed coagulation tests to measure prothrombin time (PT), endogenous thrombin potential (ETP), and activated partial thromboplastin time (aptt). A paired t test was used to determine statistical significance with ANOVA to validate the results. It was found that nonactivated PCC (Cofact) immediately reversed the effects of full-dose rivaroxaban but did not have any effect on dabigatran. However, there are many limitations with this study that need further examination. One limitation is the small sample population, creating a lack of external validity. The study looked at twelve healthy volunteers. The findings in this group cannot be accurately applied to the typical treatment population. Many hospitalized patients have impaired

4 renal function and may also have conditions that could hinder or affect the use of PCC for reversal of these agents. Another limitation is that a single standard dose of PCC was given to patients. At the conclusion of the study, results from the ETP showed an increase over time that could potentially be caused by a surplus generation of thrombin in the blood. Because of this, a smaller dose of PCC could be more beneficial in the reversal of rivaroxaban. This also could be why dabigatran appeared to be unaffected by the PCC given. If a higher dose of PCC was given to patients receiving dabigatran, there is the possibility that this could have reversed the anticoagulant effects. The other limitation of administering one dose of PCC is that it does not show if dabigatran and rivaroxaban have the potential to be reversed by alternative strategies, such as using repeated PCC administration, administering an adjunct agent such as recombinant factor VIIa, or by using recombinant factor VIIa by itself. By taking measurements between 6 and 24 hours after receipt of the PCC or placebo, the study does not take into consideration if any reversal of rivaroxaban and dabigatran was achieved in the first minutes or hours after administration. Additionally, any effects PCC may have had after the 24 hour window would not be observed [1]. Another recent study conducted in Linkoping, Sweden looked at blood samples of twenty healthy men and women. The samples were collected and then randomized. Dabigatran was dissolved in DMSO and added to the citrated blood in a standard concentration of 200 ug/l. A reversal agent was added in the smallest allowable volume to the tubes and normal saline was used as the placebo for the control tubes. The reversal agents examined for the tests were recombinant activated factor VII, activated prothrombin complex concentrate (FEIBA), and prothrombin complex concentrate (Cofact). The study showed that APCC significantly shortened clotting time in the samples but PCC had no effect. It was also observed that the

5 rfviia shortened the clotting time, but the results were not significant. One large limitation of this study was that it was conducted using only samples, so any regulatory mechanisms would not be affected by the results; thus making them less likely to be able to be applied to the population as a whole [6]. Prior to both studies, an investigation of bleeding in a rat s tail was conducted using Feiba (activated PCC). This showed that Feiba had no influence on a prolonged aptt, but did reverse the bleeding time produced by dabigatran. However, these results are surrogate markers in bleeding and do not accurately capture an active bleeding event in a human [1]. Clinical Recommendations from other Institutions Eric Liotta, a member of the Department of Neurology and Department of Pharmacology of the Feinberg School of Medicine at Northwestern University, wrote a review summarizing the available data for novel anticoagulant reversal in Although the agents undergoing clinical trial are not available at this time, the recommendation from Northwestern University is to use activated or unactivated 4-factor PCCs to reverse any of the novel anticoagulants. He recommended that institutions add this to their formulary until the new agents are available [7]. Physicians at Yale University also looked at the available data to help determine a protocol for reversal of novel anticoagulants. For reversal of dabigatran, they write: Our approach at present is to recommend drawing pretreatment laboratory tests (PT/INR, PTT, TT, and a complete blood count) and, in the event of an overdose within the past 2 hours, the administration of activated charcoal. If the patient has mild bleeding (defined as World Health Organization [WHO]

6 grade 1 2), we recommend supportive care and careful observation. If the patient has life-threatening bleeding (WHO grade 3 4), we recommend hemodialysis if (1) the patient's creatinine clearance is below 30 ml/min, (2) the patient has acute kidney injury, and (3) the last dose of dabigatran was more than 2 but less than 12 hours before presentation. If criteria for hemodialysis are not met, we recommend delaying/discontinuing dabigatran, fluid support (including blood product support) as needed, and the consideration of off-label use of 4-factor PCC (25 units/kg, dose not to exceed 2500 units). We do not recommend redosing the 4-factor PCC, nor do we recommend providing rfviia or FEIBA within 24 hours of a dose of the 4-factor PCC owing to our concern for possible thromboembolic complications. [8] When discussing their recommendations for reversal of rivaroxaban and apixaban, they state: As with dabigatran reversal, we always recommend drawing pretreatment laboratory tests (PT/INR, PTT, and a complete blood count) and, in the event of an overdose within the past 2 hours, the administration of activated charcoal. If the patient has mild bleeding (defined as WHO grade 1 2), we recommend

7 supportive care and careful observation. If the patient has life-threatening bleeding (WHO grade 3 4), we recommend delaying/discontinuing the drug in question, fluid support (including blood product support) as needed, and the consideration of off-label use of a one-time dose of the 4-factor PCC (25 units/kg, dose not to exceed 2500 units). As with dabigatran reversal, we do not recommend redosing the 4-factor PCC, nor do we recommend providing rfviia or FEIBA within 24 hours of a dose of the 4-factor PCC [8]. Doctors at the University of Pennsylvania and McMaster University compiled a flowchart suggesting management of a major bleed in patients that are taking novel oral anticoagulants [9]. [9]

8 The team suggested that non-specific pro-hemostatic agents (apcc) be given to patients with a major, life-threatening bleed even with the limited evidence available. It has been shown that apcc is preferred over 4-PCC in the available data for patients on dabigatran and that patients on rivaroxaban, apixaban, or edoxaban will benefit more from 4-PCC than apcc. Adjunctive therapies can also be used in patients for acute reversal. Hemodialysis can reduce dabigatran levels if there is bleeding caused by the medication or if the patient has renal dysfunction. It has been shown that 68% of the active dabigatran was removed after 4 hours of ingestion in patients with end-stage renal disease. Activated charcoal can also be used in patients for acute reversal of dabigatran, but there are no recommendations for patients on the other agents. The team also recommended using fresh frozen plasma only in situations where patients do not have an abundance of coagulation factor [9]. Final Recommendation Summary Based upon the clinical data and recommendations from several medical centers, I suggest that Truman Medical Center, Lakewood consider using apcc to reverse dabigatran (Pradaxa) in an emergent medical situation. If a patient recently ingested the medication, hemodialysis can be used to decrease its clinical effects. While the suggestions for reversal of dabigatran vary between using apcc and 4-PCC, it seems that apcc would be the safest and most efficacious option. I would consider using a protocol similar to the University of Pennsylvania, using 80 IU/kg in the event of a severe bleed based upon WHO criteria [9]. The evidence for reversal of the factor Xa inhibitors universally suggests 4-PCC as the best agent. I would also recommend utilizing the protocol implemented by Yale University (see

9 above) to determine when to use the reversal agent and what steps to take if an adverse bleeding event occurs while on these types of medications. While there is not a preponderance of strong evidence surrounding reversal of novel anticoagulants, there is promise for future development of agents that will work specifically to reverse these medications. Until these agents are approved for use in patients, it is important to utilize the best possible alternative in these emergent situations. References [1] Eerenberg E, Kamphuisen P, Sijpkens M, et al. Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate. American Heart Association. 2011; 124: doi: /CIRCULATIONAHA [2] Apixaban, Rivaroxaban, Dabigatran. Drug Reference Mechanism of Action. [updated 2015; cited 2015 June 11]. In: Micromedex Drug Reference Application for iphone. Ann Arbor, MI: Truven Health Analytics. C2015. [3] American College of CHEST Physicians Resources/Guidelines-and-Consensus-Statements/Antithrombotic-Guidelines-9th-EdCHEST guidelines [4] Yoonsun M, Yam F. Recent Advances in the Development of Specific Antidotes for Target- Specific Oral Anticoagulants. Pharmacotherapy. 2015; 25(2): doi: /phar [5] Siegal, D. Managing target-specific oral anticoagulant associated bleeding including an update on pharmacological reversal agents. Thrombosis Research. 2015: 39: doi: /s

10 [6] Lindahl T, Wallstedt M, Gustafsson K, et al. More efficient reversal of dabigatran inhibition of coagulation by activated prothrombin complex concentrate or recombinant factor VIIa than by four-factor prothrombin complex concentrate. Thrombosis Research. 2015; 135: doi: /j.thromres [7] Liotta E, Levasseur-Franklin K, Naidech A. Reversal of the novel oral anticoagulants dabigatran, rivoraxaban, and apixaban. Current Opinion Critical Care. 2015; 21: doi: /MCC [8] Gehrie E, Tormey C. Novel Oral Anticoagulants: Efficacy, Laboratory Measurement, and Approaches to Emergent Reversal. Archives of Pathology and Laboratory Medicine. 2015; 139(5): doi: [9] Siegal D, Cuker A. Reversal of novel oral anticoagulants in patients with major bleeding. Thrombosis Research. 2013; 35: doi: /s

To assist clinicians in the management of minor, major, and/or life-threatening bleeding in patients receiving new oral anticoagulants (NOACs).

To assist clinicians in the management of minor, major, and/or life-threatening bleeding in patients receiving new oral anticoagulants (NOACs). MANAGEMENT OF BLEEDING IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To assist clinicians

More information

Critical Bleeding Reversal Protocol

Critical 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 information

Stop 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 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 information

48 th Annual Meeting. Non-VKA Oral Anticoagulants: Prevention & Treatment of Bleeding. Terminology. Disclosure. Public Health Impact.

48 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 information

5/21/2012. Perioperative Use Issues. On admission: During hospitalization:

5/21/2012. 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 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

Disclosure. Warfarin

Disclosure. 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 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

LAMC Reversal Agent Guideline for Anticoagulants 2013. Time to resolution of hemostasis (hrs) Therapeutic Options

LAMC Reversal Agent Guideline for Anticoagulants 2013. Time to resolution of hemostasis (hrs) Therapeutic Options LAMC Reversal Agent Guideline for Anticoagulants 2013 Medication resolution of hemostasis (hrs) Intervention Administration Instructions Heparin 3-4 Protamine 1mg IV for every 100 units of heparin Slow

More information

Warfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab

Warfarin 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 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

NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl

NnEeWw 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 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

What to do in case of hemorragia. L Camoin Jau Service d Hématologie APHM Marseille

What to do in case of hemorragia. L Camoin Jau Service d Hématologie APHM Marseille What to do in case of hemorragia with NOAC? L Camoin Jau Service d Hématologie APHM Marseille Disclosure Boehringer Bayer Daishi Sanofi BMS Pharmacodynamic and kinetic properties of new oral anticoagulants.

More information

Now We Got Bad Blood: New Anticoagulant Reversal

Now 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 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

Xabans 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 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 information

Reversing the New Anticoagulants

Reversing the New Anticoagulants Reversing the New Anticoagulants Disclosure Susan C. Lambe, MD Assistant Clinical Professor Department of Emergency Medicine University of California, San Francisco Roadmap for today 1 Roadmap for today

More information

The Anticoagulated Patient A Hematologist s Perspective

The 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 information

Comparison between New Oral Anticoagulants and Warfarin

Comparison 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 information

Anticoagulation and Reversal

Anticoagulation 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 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

The management of cerebral hemorrhagic complications during anticoagulant therapy

The 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 information

Blood products and pharmaceutical emergencies

Blood products and pharmaceutical emergencies Blood products and pharmaceutical emergencies Kasey L. Bucher PharmD, BCPS Clinical Specialist, Emergency Medicine Mercy Health Saint Mary s September 12, 2013 Disclosures None significancemagazine.com

More information

Dec. 9, 2013, 11:00 a.m. EST

Dec. 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 information

New 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 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 information

COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS. TARGET AUDIENCE: All Canadian health care professionals.

COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS. TARGET AUDIENCE: All Canadian health care professionals. COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS AND PHYSICIANS TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVES: To provide a comparison of the new

More information

Reversal 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 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 information

The author has no disclosures

The author has no disclosures Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author

More information

Disclosures. Objective (NRHS) Self Assessment #2

Disclosures. 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 information

Venous Thromboembolism: Long Term Anticoagulation. Dan Johnson, Pharm.D.

Venous 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 information

The New Oral Anticoagulants: When and When Not to Use Them Philip C. Comp, M.D., Ph.D. Professor of Medicine, University of Oklahoma Health Sciences

The New Oral Anticoagulants: When and When Not to Use Them Philip C. Comp, M.D., Ph.D. Professor of Medicine, University of Oklahoma Health Sciences The New Oral Anticoagulants: When and When Not to Use Them Philip C. Comp, M.D., Ph.D. Professor of Medicine, University of Oklahoma Health Sciences Center September 25, 2015 Question: With which of the

More information

3/3/2015. Patrick Cobb, MD, FACP March 2015

3/3/2015. 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 information

2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS

2/17/2015 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 information

NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM

NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM Carol Lee, Pharm.D., Jessica C. Song, M.A., Pharm.D. INTRODUCTION For many years, warfarin

More information

PERI-OPERATIVE MANAGEMENT OF PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN,

PERI-OPERATIVE MANAGEMENT OF PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, PERI-OPERATIVE MANAGEMENT OF PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals, including primary care physicians,

More information

STARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach

STARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach STARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach Jeffrey I Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis

More information

NON-VITAMIN K ORAL ANTICOAGULANT REVERSAL

NON-VITAMIN K ORAL ANTICOAGULANT REVERSAL DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care

More information

MANAGING BLEEDING IN THE

MANAGING BLEEDING IN THE MANAGING BLEEDING IN THE SETTING OF NEW ANTICOAGULANTS: HOW DO OLD METHODS MEASURE UP? Michelle Zeller MD Clinical Hematology Fellow November 5th, 2011 A FRIDAY NIGHT ON-CALL WITH DR. B. LUD Very keen

More information

Title of Guideline. Thrombosis Pharmacist)

Title of Guideline. Thrombosis Pharmacist) Title of Guideline Contact Name and Job Title (author) Guideline for patients receiving Rivaroxaban (Xarelto ) requiring Emergency Surgery or treatment for Haemorrhage Julian Holmes (Haemostasis and Thrombosis

More information

Traditional anticoagulants

Traditional 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 information

New 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 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 information

East Kent Prescribing Group

East Kent Prescribing Group East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal

More information

New Anticoagulants: What to Use What to Avoid

New 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 information

Impact of new (direct) oral anticoagulants in patient blood management

Impact of new (direct) oral anticoagulants in patient blood management Impact of new (direct) oral anticoagulants in patient blood management Yulia Lin, MD, FRCPC, CTBS Transfusion Medicine & Hematology, Sunnybrook Health Sciences Centre Dept of Laboratory Medicine & Pathobiology,

More information

EMMC Guide on Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults. February, 2013

EMMC Guide on Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults. February, 2013 EMMC Guide on Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults February, 2013 1 Quick Index To Reversal Recommendations Anti-Platelet Medications Page P2Y12

More information

Reversal of Anticoagulants at UCDMC

Reversal of Anticoagulants at UCDMC Reversal of Anticoagulants at UCDMC Introduction: Bleeding complications are a common concern with the use of anticoagulant agents. In selected situations, reversing or neutralizing the effects of an anticoagulant

More information

New Oral Anticoagulants. Pharmacological considerations

New Oral Anticoagulants. Pharmacological considerations New Oral Anticoagulants Pharmacological considerations New oral anticoagulants The ideal anticoagulant. Metabolic pathways Drug-drug interactions One dose fits all??? Special sub-groups of patients. NOAC

More information

New Oral Anticoagulants

New Oral Anticoagulants Laboratory Monitoring of New Oral Anticoagulants.....What you need to know Rita Selby MD Medical Director, Coagulation Laboratories Uniersity Health Network & Sunnybrook HSC Uniersity of Toronto The 15

More information

The Role of the Newer Anticoagulants

The 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 information

Novel Anticoagulation Agents DISCLOSURES. Objectives ATRIAL FIBRILLATION TRIALS. NOAC Comparison 6/12/2015

Novel 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 information

DOACs. What s in a name? or TSOACs. Blood Clot. Darra Cover, Pharm D. Clot Formation DOACs work here. Direct Oral AntiCoagulant

DOACs. 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 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

DISCLOSURES CONFLICT CATEGORY. No conflict of interest to disclose

DISCLOSURES 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 information

Thrombosis and Hemostasis

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 information

Cardiology Update 2014

Cardiology 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 information

New Oral Anticoagulant (Rivaroxaban [Xarelto])

New Oral Anticoagulant (Rivaroxaban [Xarelto]) TABLE OF CONTENTS New Oral Anticoagulant (Rivaroxaban [Xarelto]) 1-2 New Antiplatelet (Ticagrelor [Brilinta]) 2-3 Update on Dabigatran (Pradaxa) Safety and Use at UIMCC 3-4 What Methods are Available for

More information

NON-VITAMIN K ORAL ANTICOAGULANT REVERSAL

NON-VITAMIN K ORAL ANTICOAGULANT REVERSAL DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care

More information

QUICK REFERENCE. Mary Cushman 1 Wendy Lim 2 Neil A Zakai 1. University of Vermont 2. McMaster University

QUICK REFERENCE. Mary Cushman 1 Wendy Lim 2 Neil A Zakai 1. University of Vermont 2. McMaster University QUICK REFERENCE Clinical Practice Guide on Antithrombotic Drug Dosing and Management of Antithrombotic Drug- Associated Bleeding Complications in Adults February 2014* Mary Cushman 1 Wendy Lim 2 Neil A

More information

Current and Emerging Therapies for Perioperative Anticoagulation Reversal

Current and Emerging Therapies for Perioperative Anticoagulation Reversal Current and Emerging Therapies for Perioperative Anticoagulation Reversal Eric Johnson, PharmD, BCCCP Critical Care Pharmacist- Perioperative Services Objectives Detail the approach to perioperative anticoagulation

More information

Oral anticoagulants new and old: bleeding risk and management strategies. Logan Tinsen Pharm.D. Benefis Hospitals

Oral anticoagulants new and old: bleeding risk and management strategies. Logan Tinsen Pharm.D. Benefis Hospitals Oral anticoagulants new and old: bleeding risk and management strategies Logan Tinsen Pharm.D. Benefis Hospitals Disclaimer! I am not receiving any compensation from any drug company! Any opinions I may

More information

Reversing novel anticoagulants to divert catastrophe SEAN P. WILSON, MD DEPARTMENT OF EMERGENCY MEDICINE HENRY FORD HOSPITAL, DETROIT, MI

Reversing novel anticoagulants to divert catastrophe SEAN P. WILSON, MD DEPARTMENT OF EMERGENCY MEDICINE HENRY FORD HOSPITAL, DETROIT, MI Reversing novel anticoagulants to divert catastrophe SEAN P. WILSON, MD DEPARTMENT OF EMERGENCY MEDICINE HENRY FORD HOSPITAL, DETROIT, MI Novel anticoagulants? Dabigatran (Pradaxa) Stroke and systemic

More information

Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia

Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Insertion, removal or presence of a catheter in selected sites can place a patient who is antithrombotic agent at risk for a local bleeding

More information

1/12/2016. What s in a name? What s in a name? NO.Anti-Coagulation. DOACs in clinical practice. Practical aspects of using

1/12/2016. What s in a name? What s in a name? NO.Anti-Coagulation. DOACs in clinical practice. Practical aspects of using What s in a name? Practical aspects of using DOACs (Direct Oral Anticoagulants) James L. Sebastian, MD, MACP Professor of Medicine (GIM) Medical College of Wisconsin February 5, 2016 DOAC NOAC NOAC ODI

More information

Committee Approval Date: September 12, 2014 Next Review Date: September 2015

Committee 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 information

No more rat poison? New oral anticoagulants and perioperative considerations

No more rat poison? New oral anticoagulants and perioperative considerations 1 No more rat poison? New oral anticoagulants and perioperative considerations Jerrold H. Levy, MD, FAHA, FCCM Professor Department of Anesthesiology/Critical Care Duke University School of Medicine Durham,

More information

Making Sense of the Newer Anticoagulants

Making Sense of the Newer Anticoagulants Making Sense of the Newer Anticoagulants Brian Tiffany, MD, PhD, FACEP Dept of Emergency Medicine Chandler Regional Medical Center Mercy Gilbert Medical Center I M FROM ARIZONA! DISCLOSURES No relevant

More information

New Oral Anticoagulants in AF Unresolved issues

New Oral Anticoagulants in AF Unresolved issues STAIR VIII Accelerating the Evolution of Stroke Therapies New Oral Anticoagulants in AF Unresolved issues Sheraton Pentagon City Hotel March 9, 2013 Agenda 1. Monitoring anticoagulant effects 2. Reversal

More information

Devang 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 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 information

CHALLENGES AND OPPORTUNITIES IN CLINICAL USE OF THE NEW ORAL ANTICOAGULANTS. Amy Giovino, PharmD Formulary Coordinator Sarasota Memorial Hospital

CHALLENGES AND OPPORTUNITIES IN CLINICAL USE OF THE NEW ORAL ANTICOAGULANTS. Amy Giovino, PharmD Formulary Coordinator Sarasota Memorial Hospital CHALLENGES AND OPPORTUNITIES IN CLINICAL USE OF THE NEW ORAL ANTICOAGULANTS Amy Giovino, PharmD Formulary Coordinator Sarasota Memorial Hospital 1 2 Disclosure I do not have a vested interest in or affiliation

More information

Post-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 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 information

Prescriber Guide. 20mg. 15mg. Simply Protecting More Patients. Simply Protecting More Patients

Prescriber 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 information

Thrombosis 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 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 information

Disclosure. Outline. Objectives. I have no actual or potential conflict of interest in relation to this presentation.

Disclosure. 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 information

Clinical Guideline N/A. November 2013

Clinical Guideline N/A. November 2013 State if the document is a Trust Policy/Procedure or a Clinical Guideline Clinical Guideline Document Title: Document Number 352 Version Number 1 Name and date and version number of previous document (if

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

Analyzing 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 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 information

New Oral Anticoagulants

New 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 information

Laboratory Testing in Patients on Novel Oral Anticoagulants (NOACs)

Laboratory Testing in Patients on Novel Oral Anticoagulants (NOACs) Laboratory Testing in Patients on Novel Oral Anticoagulants (NOACs) Dr. Art Szkotak artur.szkotak@albertahealthservices.ca University of Alberta Hospital Edmonton, AB NOACs Direct Thrombin Inhibitors (DTI):

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

New Oral Anticoagulants. How safe are they outside the trials?

New 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 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

Guidelines for the Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults

Guidelines for the Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults Guidelines for the Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults Purpose: To be used as a common tool for all practitioners involved in the care of patients

More information

Top 10 Thrombosis and Anticoagulation Highlights from ASH 2014

Top 10 Thrombosis and Anticoagulation Highlights from ASH 2014 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

More information

The Brave New (Anticoagulant) World

The 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 information

FDA Approved Oral Anticoagulants

FDA Approved Oral Anticoagulants FDA Approved Oral Anticoagulants Generic (Trade Name) Warfarin (Coumadin, Jantoven ) 1 FDA approved indication Prophylaxis and treatment of venous thromboembolism (VTE) Prophylaxis and treatment of thromboembolic

More information

ABOUT XARELTO CLINICAL STUDIES

ABOUT 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 information

Guideline for the Prescribing of Novel Oral Anticoagulants (NOACs): Dabigatran (Pradaxa ), Rivaroxaban (Xarelto ), Apixaban (Eliquis )

Guideline for the Prescribing of Novel Oral Anticoagulants (NOACs): Dabigatran (Pradaxa ), Rivaroxaban (Xarelto ), Apixaban (Eliquis ) Guideline for the Prescribing of Novel Oral Anticoagulants (NOACs): Dabigatran (Pradaxa ), Rivaroxaban (Xarelto ), Apixaban (Eliquis ) The contents of this CPG are to be used as a guide. Healthcare professionals

More information

The speakers have attested that their presentation will be free of all commercial bias toward a specific company and its products.

The 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 information

The New Anticoagulants are Here! Do you know how to use them? Arrhythmia Winter School February 11 th, 2012. Jeff Healey

The New Anticoagulants are Here! Do you know how to use them? Arrhythmia Winter School February 11 th, 2012. Jeff Healey The New Anticoagulants are Here! Do you know how to use them? Arrhythmia Winter School February 11 th, 2012 Jeff Healey RELY: A New Era in AF Connolly SJ et al. N Engl J Med 2009;361:1139-1151 ROCKET-AF:

More information

Dr Gordon Royle Haematologist, Middlemore Hospital

Dr Gordon Royle Haematologist, Middlemore Hospital The New Oral Anticoagulants (NOACs) Dr Gordon Royle Haematologist, Middlemore Hospital Disclaimers Boehringer-Ingelheim Bayer Sanofi Douglas Pharmaceuticals Preventing disasters: lessons learned A cautionary

More information

New Oral Anticoagulants. July 2012

New Oral Anticoagulants. July 2012 New Oral Anticoagulants July 2012 Objectives Review coagulation cascade and previous treatment options for anticoagulation Understand points of interaction within coagulation cascade and new oral agents

More information

Advanced Issues in Peri-Operative VTE Prevention

Advanced 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 information

DABIGATRAN ETEXILATE TARGET Vitamin K epoxide reductase WARFARIN RIVAROXABAN APIXABAN

DABIGATRAN ETEXILATE TARGET Vitamin K epoxide reductase WARFARIN RIVAROXABAN APIXABAN TARGET SPECIFIC ORAL ANTICOAGULANTS (TSOACs) This document is intended as a guideline only and should not replace sound clinical judgment Please refer to UNMH formulary in Lexicomp for approved use(s)

More information

Disclosures. New Developments in Oral Anticoagulants: Treating and Preventing Embolic Events in the 21 st Century

Disclosures. New Developments in Oral Anticoagulants: Treating and Preventing Embolic Events in the 21 st Century New Developments in Oral Anticoagulants: Treating and Preventing Embolic Events in the 21 st Century David Stewart, PharmD, BCPS Associate Professor of Pharmacy Practice East Tennessee State University

More information

Recommendations on Use of Dabigatran in Atrial Fibrillation

Recommendations on Use of Dabigatran in Atrial Fibrillation Recommendations on Use of Dabigatran in Atrial Fibrillation Developed by participants from the Section of Hematology/Oncology and Section of Cardiology, and Faculty of Pharmacy, University of Manitoba

More information

Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism

Rivaroxaban 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 information

How does warfarin work? We know itʼs a vitamin k antagonist, but what does that mean? What's really getting antagonized?

How does warfarin work? We know itʼs a vitamin k antagonist, but what does that mean? What's really getting antagonized? Anticoagulation reversal Vitamin K antagonists and New Oral Anticoagulants Robert Orman, MD Warfarin How does warfarin work? We know itʼs a vitamin k antagonist, but what does that mean? What's really

More information

Update on Antiplatelets and anticoagulants. Outlines. Antiplatelets and Anticoagulants 1/23/2013. Timir Paul, MD, PhD

Update on Antiplatelets and anticoagulants. Outlines. Antiplatelets and Anticoagulants 1/23/2013. Timir Paul, MD, PhD Update on Antiplatelets and anticoagulants Timir Paul, MD, PhD Antiplatelets Indications Doses Long term use (beyond 12 months) ASA and combination use of NSAIDS ASA resistance Plavix resistance Plavix

More information

Dr Gordon Royle Haematologist, Middlemore Hospital

Dr Gordon Royle Haematologist, Middlemore Hospital The New Oral Anticoagulants (NOACs) Dr Gordon Royle Haematologist, Middlemore Hospital Disclaimers Boehringer-Ingelheim Bayer Sanofi Douglas Pharmaceuticals Preventing disasters: lessons learned A cautionary

More information