New Oral Anticoagulants. Pharmacological considerations

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "New Oral Anticoagulants. Pharmacological considerations"

Transcription

1 New Oral Anticoagulants Pharmacological considerations

2 New oral anticoagulants The ideal anticoagulant. Metabolic pathways Drug-drug interactions One dose fits all??? Special sub-groups of patients. NOAC s-induced bleeding complications how to treat?

3 Why not warfarin? Narrow therapeutic index Large inter-individual variability in doseeffect relationship. Slow onset of action Slow offset of action (pharmacokinetic and pharmacodynamic) Multiple drug and dietary interactions Requires monitoring to maintain in therapeutic range.

4 Why not warfarin? Efficacy is dependent upon infrastructure: TTR (time in therapeutic range) is associated with improved safety and efficacy. TTR is improved with specialized AC programs. TTR is improved in countries with developed health care infrastructure

5 The ideal anticoagulant Oral administration. Rapid onset/offset of action. Wide therapeutic range. Predictable therapeutic effect with fixed or weight-based dosing. No drug-drug or drug-food interactions. No monitoring required (but ability to monitor is desired) Easily reversible Well defined pharmacokinetics in renal dysfunction. Cost-effective.

6 New Oral Anticoagulants (DOAC s) Direct Thrombin inhibitors: Dabigatran (Pradaxa) Factor Xa inhibitors: Rivaroxaban (Xarelto) Apixaban (Eliquis).

7 DOAC s mechanism of action

8 Apixaban ELIQUIS Factor Xa inhibitor, reversible לא 50% 8-14 Rivaroxaba n XARELTO Factor Xa inhibitor, reversible לא 66% קיבה ריקה 90%~ עם אוכל 5-13 Dabigatra n PRADAXA Direct thrombin inhibitor, reversible כן 3-7% כבדי לא כן כבדי בעיקר ע"י CYP3A4/5 כן כבדי בעיקר ע"י CYP3A4/5 כן 27% 33% 80% השם הגנרי השם המסחרי מנגנון פעולה Pro-drug זמינות ביולוגית זמן מחצית חיים )שעות( מטבוליזם מטבוליזם CYP סובסטרט של P-gp % פינוי כלייתי התאמת מינון באס"כ השפעה למזון נדרשת אין השפעה נדרשת מעלה ספיגה בכ- נדרשת אין השפעה

9

10

11

12

13

14

15 DOAC s drug interactions

16 DOAC s drug interactions

17 Dabigatran Drug interactions

18 * * * *

19 One dose fits all? Trough [dabigatran] Bleeder? Stroke?

20 A pre-specified analysis of RE-LY 9183 patients tested on BID doses Analyzed- 112 SSE events (1.3%) 323 bleeding events (3.8%) 1 outcome blood level and risk of AE DAB levels depended on renal function, age, weight, female gender

21 1% 3.5%

22 Source FDA EMA Dose 150 bid 75 bid? 150 bid 110 bid Dose adjustment NO Age > 75 Therapeutic level ng/ml Mandatory monitoring? NO YES

23 Outcomes in relation to Renal function

24 NOACs in CKD (egfr <50 ml/min) Trial egfr <50 ml/min Results RE-LY 1,2 3,505 ROCKET- AF 3 ARISTOTLE 4 2,950 3,017 Consistent results* Consistent results** Less bleeding in patients with CKD** * Dose was randomized **Dose reduced in patients with renal impairment and/or those at risk of bleeding 1. Connolly SJ, et al. N Engl J Med 2009;361: ; 2. Eikelboom JW, et al. Circulation 2011;123: ; 3. Patel MR, et al. N Engl J Med 2011;365: ; 4. Granger CB, et al. N Engl J Med 2011;365:

25 NOACs in CKD (egfr <50 ml/min) Renal function Expert Rev Cardiovasc. Ther. 11(8), 2013

26 Age above 75

27 NOACs in Elderly Patients (AGE 75) Trial AGE 75 Results RE-LY 1,2 7,258 ROCKET- AF 3 ARISTOTLE 4 6,229 5,678 More Bleedings in Elderly Patients Consistent results Consistent results * Dose was randomized **Dose reduced in patients with renal impairment and/or those at risk of bleeding 1. Connolly SJ, et al. N Engl J Med 2009;361: ; 2. Eikelboom JW, et al. Circulation 2011;123: ; 3. Patel MR, et al. N Engl J Med 2011;365: ; 4. Granger CB, et al. N Engl J Med 2011;365:

28 NOACs vs. Warfarin Stroke in the younger and elderly Barco S, et al. Hematology 2013; 26:

29 NOACs vs. Warfarin Major bleedings in the younger and elderly Barco S, et al. Hematology 2013; 26:

30 OD or BID dosing? 31

31 Acute vs. chronic disease (adherence > 6 mo) Clinical study participation Drug schedule cost 32

32

33 Frost et al. Clinical pharmacology 2014:6

34 Treatment of bleeding

35 BLEEDING GENERAL OTHER REPLACEMENT ANTIDOTE? Measure Charcoal Hemodialysis FFP PCC rfviia rfx Antidot PRADAXA? NA soon Rivaroxaban Apixaban NO data Not likely to help. NO data. NO data soon?? soon 36

36 12 healthy male volunteers RCT - crossover Rivaroxaban 20 mg OD, dabigatran 150 mg BID Received PCC after each anticoagulant

37 PT ETP Rivaroxaban Pradaxa PTT TT

38 5 patients on dabigatran All on 110 mg BID for a median of 27 days Rx duration One patient died of bleeding and sepsis In 4 bleeding stopped. NO thrombosis at 6m FU

39

40 Specific antidote IDAROCIZUMAB fully humanized Fab administered IV High affinity to DAB (X350) NO pro or antithrombotic effects Short half life NO other endogenous targets

41 344 Idarucizumab, a Specific Antidote for Dabigatran: Immediate, Complete and Sustained Reversal of Dabigatran Induced Anticoagulation in Elderly and Renally Impaired Subjects IDAROCUZIMAB 2 RCTs on healthy volunteers and renally impaired (mild-moderate) Increasing doses 1, ,5 BID, 5 mg Complete reversal of DAB w/o side effects

42 Specific antidote Modified factor X (rfx) Removal of active + GLA binding sites Xa inhibitor binding not affected No effect of FX activity when administered alone X X 43

43 ANDEXANATE ALFA Portola pharmaceuticals Phase I+II studies 65 patients > 90% inhibition of Apixaban within 2 minutes lasting 120 minutes ( with infusion) No Abs, no thrombosis

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

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

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

PGY1 Pharmacy Practice St. Vincent Hospital PGY2 Ambulatory Care St. Vincent Primary Care Center

PGY1 Pharmacy Practice St. Vincent Hospital PGY2 Ambulatory Care St. Vincent Primary Care Center 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 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

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

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

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

4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71

4/9/2015. 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 information

Xarelto (Rivaroxaban)

Xarelto (Rivaroxaban) Xarelto (Rivaroxaban) Hightly selective, reversible, direct oral FXa inhibitor Maxium concentratiion after 2 to 4 hrs High bioavailability(66%),increase with food ( suggest with food) 1/3 from renal excretion,

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

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

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

} Most common arrhythmia. } Incidence increases with age. } Anticoagulants approved for AF

} Most common arrhythmia. } Incidence increases with age. } Anticoagulants approved for AF Deniz Yavas, PharmD PGY-2 Ambulatory Care Pharmacy Resident Detroit Veterans Affairs Medical Center } Most common arrhythmia 0.4-1% of Americans (2.2 mil people) 1,2 } Incidence increases with age 6% (65

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

1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF

1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF Objectives Atrial Fibrillation and Prevention of Thrombotic Complications: Therapeutic Update Andrea C. Flores Pharm.D Pharmacy Resident at the Miami VA Healthcare System Review the epidemiology, pathophysiology

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

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

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

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:

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

Adherence to NOACs. Disclosure. Patricia van den Bemt EAHP Hamburg 2015

Adherence 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 information

Novel OACs: How should we use them?"

Novel OACs: How should we use them? Novel OACs: How should we use them?" Iqwal Mangat, MD FRCPC" Director, Arrhythmia Service, St. Michaelʼs Hospital" Assistant Professor of Medicine, University of Toronto" Presenter Disclosure Dr. Iqwal

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

Novel OAC s : How should we use them?

Novel OAC s : How should we use them? Novel OAC s : How should we use them? Jean C. Grégoire MD, FRCP(c), FACC, FACP Associate Professor, Université de Montréal, IntervenJonal Cardiologist, InsJtut de cardiologie de Montréal Disclosures Speaker

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION

STROKE PREVENTION IN ATRIAL FIBRILLATION STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients

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

Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013

Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Family physician with Rivergrove Medical Clinic Practice in the north end since 1985 Medical Director of the Wellness

More information

Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs

Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose Warfarin vs the NOACs Dr. Lori McIntosh D.O. Board Certified Neurologist Objectives Be able to list the current options of

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

Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Brief Comparison of Four Agents

Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Brief Comparison of Four Agents Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Brief Comparison of Four Agents Abbreviations AF: Atrial fibrillation ARISTOTLE: Apixaban for Reduction in Stroke and Other Thromboembolic

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

Breadth of indications matters One drug for multiple indications

Breadth 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 information

Practical everyday use of NOACs. Dr. Elisabetta Toso SOC Cardiologia Ospedale Cardinal Massaia - Asti

Practical everyday use of NOACs. Dr. Elisabetta Toso SOC Cardiologia Ospedale Cardinal Massaia - Asti Practical everyday use of NOACs Dr. Elisabetta Toso SOC Cardiologia Ospedale Cardinal Massaia - Asti THE NEW ANTICOAGULANTS HISTORY Oral Inhibitors Edoxaban Apixaban Betrixaban EXPLORE-Xa Phase II trial

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

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

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

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

Objectives. New and Emerging Anticoagulants. Objectives (continued) 2/18/2014. Development of New Anticoagulants

Objectives. New and Emerging Anticoagulants. Objectives (continued) 2/18/2014. Development of New Anticoagulants Objectives New and Emerging Anticoagulants Adraine Lyles, PharmD, BCPS Clinical Pharmacy Specialist VCU Medical Center Describe the pharmacology of the novel oral anticoagulants Discuss the clinical evidence

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

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

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

3/25/14. To Clot or Not What s New In Anticoagulation? Clotting Cascade. Anticoagulant drug targets. Anita Ralstin, MS CNS CNP. Heparin.

3/25/14. To Clot or Not What s New In Anticoagulation? Clotting Cascade. Anticoagulant drug targets. Anita Ralstin, MS CNS CNP. Heparin. To Clot or Not What s New In Anticoagulation? Anita Ralstin, MS CNS CNP 1 Clotting Cascade 2 Anticoagulant drug targets Heparin XI VIII IX V X VII LMWH II Warfarin Fibrin clot 1 Who Needs Anticoagulation

More information

Recommendation for the Reversal of Novel Anticoagulants in Emergent Situations

Recommendation 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 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

Out 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 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

New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013

New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7

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

Anticoagulant Treatment for Deep Venous Thrombosis Direct Oral Anticoagulants (NOACs)

Anticoagulant 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 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

New Anticoagulants. Stroke Prevention in AF Commencing Novel Oral Anticoagulants (NOACs) in the GP Setting. 30-Oct-14

New Anticoagulants. Stroke Prevention in AF Commencing Novel Oral Anticoagulants (NOACs) in the GP Setting. 30-Oct-14 Stroke Prevention in AF Commencing Novel Oral Anticoagulants (NOACs) in the GP Setting A/Prof Michael Nguyen Fremantle Hospital Access Cardiology General Practice Education Day Oct 2014 ORAL TTP889 Rivaroxaban

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 oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations

Novel 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 information

Failure or significant adverse effects to all of the alternatives: Eliquis and Xarelto

Failure 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 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

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

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

9/8/2014. None. Identify the under-recognized risk of cardioembolic stroke in untreated and undertreated. morbidity, mortality and cost burdens

9/8/2014. None. Identify the under-recognized risk of cardioembolic stroke in untreated and undertreated. morbidity, mortality and cost burdens Optimizing Anticoagulation Therapy for Older Adults with Atrial Fibrillation: The New Oral Agents" None Disclosures Brad Hein, PharmD Associate Professor of Pharmacy The University of Cincinnati Winkle

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

Goals 6/6/2014. Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs. Ashkan Babaie, MD

Goals 6/6/2014. Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs. Ashkan Babaie, MD Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs Ashkan Babaie, MD Arrhythmia Service Providence Heart Clinic June 8 th, 2014 Goals Discuss the data behind approval of NOACs

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

A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS BRIAN CRYDER, PHARMD BCACP

A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS BRIAN CRYDER, PHARMD BCACP A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS BRIAN CRYDER, PHARMD BCACP LEARNING OBJECTIVES AS A RESULT OF THIS PRESENTATION, THE AUDIENCE WILL BE ABLE TO 1. DISCUSS THE KEY DIFFERENCES BETWEEN

More information

A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS

A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS BRIAN CRYDER, PHARMD BCACP LEARNING OBJECTIVES AS A RESULT OF THIS PRESENTATION, THE AUDIENCE WILL BE ABLE TO 1. DISCUSS THE KEY DIFFERENCES BETWEEN

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

New Anticoagulants: When and Why Should I Use Them? Disclosures

New 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 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

23/06/2014. Implications for the Gastroenterologist. No financial interests I am not a hematologist

23/06/2014. 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 information

Cardiovascular Subcommittee of PTAC Meeting held 27 February 2014. (minutes for web publishing)

Cardiovascular Subcommittee of PTAC Meeting held 27 February 2014. (minutes for web publishing) Cardiovascular Subcommittee of PTAC Meeting held 27 February 2014 (minutes for web publishing) Cardiovascular Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology

More information

ΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ. Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν

ΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ. Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν ΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν The AF epidemic Mayo Clinic data (assuming a continued increase in the AF incidence) Mayo

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

New Oral Anticoagulants

New Oral Anticoagulants Disclosures The New Oral Anticoagulants: Are they better than Warfarin? Alan P. Agins, Ph.D. does not have any actual or potential conflicts of interest in relation to this CE activity. Alan Agins, Ph.D.

More information

Efficacy in Hip Arthroplasty. Efficacy in Knee Arthroplasty. Adverse Effects. Drug Interactions

Efficacy in Hip Arthroplasty. Efficacy in Knee Arthroplasty. Adverse Effects. Drug Interactions Objectives Just for the RECORD: Rivaroxaban joins the US Anticoagulation Arsenal Anne P. Spencer, PharmD, FCCP, BCPS (AQ Cardiology) Cardiovascular Care Pharmacy Specialist Roper Saint Francis Healthcare

More information

New Oral AntiCoagulants (NOAC) in 2015

New Oral AntiCoagulants (NOAC) in 2015 New Oral AntiCoagulants (NOAC) in 2015 William R. Hiatt, MD Professor of Medicine and Cardiology University of Colorado School of Medicine President CPC Clinical Research Disclosures Received research

More information

Anticoagulation For Atrial Fibrillation

Anticoagulation For Atrial Fibrillation Anticoagulation For Atrial Fibrillation New Agents In A New Era Arjun V Gururaj, MD Arrhythmia and Electrophysiology Nevada Heart and Vascular Center Disclosures Biotronik Speaker Clinical investigator

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

Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014

Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014 Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014 Atrial Fibrillation 2 Atrial Fibrillation The most common arrhythmia encountered

More information

Management of Antithrombotics with Procedures. Jordan Weinstein, MD

Management of Antithrombotics with Procedures. Jordan Weinstein, MD Management of Antithrombotics with Procedures Jordan Weinstein, MD Presenter Disclosure Information Cardiology Update 2013 I have no relevant financial interest and/or arrangement with industry. Novel

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

Correlation of Drug Levels and Outcomes in Phase III New Oral Anticoagulant (NOAC) Trials

Correlation of Drug Levels and Outcomes in Phase III New Oral Anticoagulant (NOAC) Trials Correlation of Drug Levels and Outcomes in Phase III New Oral Anticoagulant (NOAC) Trials October 26, 2015 CDER/OTS/OCP/DPM Jeffry Florian, Ph.D. CDER/OND/ODE1/DCRP Martin Rose, M.D. 1 Outline Overview

More information

Novel Oral Anticoagulants (NOACs) Prescriber Update 2013

Novel Oral Anticoagulants (NOACs) Prescriber Update 2013 Novel Oral Anticoagulants (NOACs) Prescriber Update 2013 Indications/Contraindications Indications Orthopedic VTE Prophylaxis VTE Treatment Stroke Prevention for non-valvular AF Contraindications 150 mg

More information

Anticoagulants. Denver Health April 12, 2011

Anticoagulants. Denver Health April 12, 2011 New Oral Anticoagulants Rebecca Hanratty, MD Denver Health April 12, 2011 Overview Why we need alternatives to warfarin Review of the 3 new oral anticoagulants Results from major trials: Thromboprophylaxis

More information

Disclosure/Conflict of Interest

Disclosure/Conflict of Interest NEW ORAL ANTICOAGULANTS: WHAT EVERY PHARMACIST SHOULD KNOW LORI B. HORNSBY, PHARMD, BCPS ASSOCIATE CLINICAL PROFESSOR AUHSOP CLINICAL PHARMACIST MIDTOWN MEDICAL CENTER OUTPATIENT CLINIC COLUMBUS, GEORGIA

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

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

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

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

NOAC S For Stroke Prevention in. Atrial Fibrillation. Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health

NOAC S For Stroke Prevention in. Atrial Fibrillation. Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health NOAC S For Stroke Prevention in Atrial Fibrillation Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health New Oral Anti Coagulant Formal Definition: Atrial Fibrillation

More information

Management of atrial fibrillation. Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD

Management of atrial fibrillation. Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD Management of atrial fibrillation Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD Antithrombotic therapy in atrial fibrillation Satchana Pumprueg, MD AF has serious consequences Independent

More information

Anticoagulation in Atrial Fibrillation

Anticoagulation in Atrial Fibrillation Anticoagulation in Atrial Fibrillation Parag P. Patel, MD FACC Disclosures Eliquis Speakers Bureau 1 Clinical Scenario Ms. L is a 76F admitted to the stroke service with a dense right sided hemiparesis

More information

Traveller s Thrombosis. Dr. Peter Verhamme Vascular Medicine and Haemostasis UZ Leuven

Traveller 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 information

Antiplatelet and Antithrombotics From clinical trials to guidelines

Antiplatelet and Antithrombotics From clinical trials to guidelines Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories

More information

Which Drugs to Use? Dr Curry Grant Stroke Prevention Clinic Quinte Health Care

Which Drugs to Use? Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Which Drugs to Use? Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE: Support provided

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

The 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era. CCRN State of the Heart 2012 June 2, 2012

The 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era. CCRN State of the Heart 2012 June 2, 2012 The 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era CCRN State of the Heart 2012 June 2, 2012 Disclosures I have I have been involved in trials of new anticoagulants and have received

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

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

Analytical Specifications RIVAROXABAN

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

More information

Bleeding Associated with NOACs: Assesing the Risk and Management

Bleeding Associated with NOACs: Assesing the Risk and Management Samama MM Bleeding Associated with NOACs: Assesing the Risk and Management David Varon Batia Roth-Yelinek Hadassah Hebrew University Hospital Jerusalem Consulting disclosures Pfizer, Rafa Balancing between

More information

Anti Coagulation for Stroke Prevention in Atrial Fibrillation The Case for Coumadin vs. NOACS

Anti Coagulation for Stroke Prevention in Atrial Fibrillation The Case for Coumadin vs. NOACS Anti Coagulation for Stroke Prevention in Atrial Fibrillation The Case for Coumadin vs. NOACS Cardiac Electrophysiology, Cardiology Department Meir Medical Center מודיעין על היריב ד"ר לילך דולב אחראית

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