HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below

Size: px
Start display at page:

Download "HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below"

Transcription

1 Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications Date decision last revised Selective direct factor Xa inhibitor See below September 203 (update of vember 202 HMMC recommendation) Decision status Final NICE guidance NICE TA 57, recommended, NICE TA 256, recommended, NICE TA 26, recommended, NICE TA 287 recommended. Licensed Indications Rivaroxaban is an orally active antithrombotic agent and holds a UK marketing authorisation for: Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation with one or more risk factors, such as congestive heart failure, hypertension, age >75 years, diabetes mellitus, prior stroke or transient ischaemic attack., AND the primary prevention of venous thromboembolic events in adult patients who have undergone elective total hip replacement surgery or total knee replacement surgery, AND Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults RIVAROXABAN FOR USE IN PATIENTS UNDERGOING HIP AND KNEE REPLACEMENT NICE TA57 recommends rivaroxaban as a treatment option. Rivaroxaban for primary prevention of venous thromboembolic events in patients who have had a hip or knee operation is included within the tariff price for the procedure. GPs should NOT prescribe rivaroxaban for this indication. RIVAROXABAN FOR USE IN PATIENTS WITH NON VALVULAR ATRIAL FIBRILLATION Recommended for primary or secondary care prescribing for non valvular atrial fibrillation in line with algorithm (see pg 3). Supporting documents are available to assist in the anticoagulant decision making process, highlighting the benefits and risks of the various treatment options to support clinician/patient discussions: Full guidance NOACs in non-valvular AF Algorithm for oral anticoagulant choice in non-valvular AF Comparison of NOACs and warfarin Patient agreement for NOACs Anticoagulant choice for atrial fibrillation patient information Template letter from specialist to primary care following initiation of rivaroxaban for stroke prevention in AF All patients with AF must have a CHADS 2 score documented, and bleeding risk assessment. NICE recommendation, TA256 Rivaroxaban is recommended as an option for the prevention of stroke and systemic embolism within its licensed indication, that is, in people with non-valvular atrial fibrillation with one or more risk factors such as: o congestive heart failure o hypertension o age 75 years or older o diabetes mellitus, o prior stroke or transient ischaemic attack. The decision about whether to start treatment with rivaroxaban should be made after an informed discussion between the clinician and the person about the risks and benefits of rivaroxaban compared with warfarin. For people who are taking warfarin, the potential risks and benefits of switching to rivaroxaban should be considered in light of their level of international normalised ratio (INR) control.

2 RIVAROXABAN FOR THE TREATMENT OF DVT AND PREVENTION OF RECURRENT DVT/PE AFTER A DIAGNOSIS OF DVT NICE Recommendation, TA26, states that rivaroxaban is recommended as an option for treating deep vein thrombosis and preventing recurrent deep vein thrombosis and pulmonary embolism after a diagnosis of acute deep vein thrombosis in adults. In line with NICE recommendations, local haematologists have identified patients with provoked DVT as a priority group within Hertfordshire. Therefore, following local agreement with specialists within Hertfordshire, rivaroxaban is recommended for the treatment of provoked deep vein thrombosis where there is no contraindication to rivaroxaban, for a treatment period of 3 months. Initiation to be undertaken by secondary care specialist: 5mg twice daily for 3 weeks. Follow on prescribing to be undertaken by primary care: 20mg daily for the remainder of the treatment course (3 months in total). For patients with creatinine clearance 5-49ml/min, an appropriate continuation dose will be advised by the haematologist. The product literature states that a reduction of the continuation dose from 20 mg once daily to 5 mg once daily can be considered if the patient's assessed risk for bleeding outweighs the risk for recurrent DVT. The continuation dose should be given for the remainder of the treatment course (3 months in total). Initiation dose remains as above. For patients with creatinine clearance <5ml/min, rivaroxaban is not recommended. RIVAROXABAN FOR THE TREATMENT OF PE IN ADULTS, AND PREVENTING RECURRENT VTE NICE Recommendation, TA287, states that rivaroxaban is recommended as an option for treating pulmonary embolism and preventing recurrent deep vein thrombosis and pulmonary embolism in adults. HMMC recommendation: where rivaroxaban is chosen as the treatment of choice, GPs are to be informed of the following to ensure safe management: specific indication dose duration of treatment patient s current renal function and haemoglobin at treatment initiation Further prescribing information can be accessed at References: NICE TA57: Rivaroxaban for the prevention of venous thromboembolism after hip or knee replacement surgery in adults, June 20, NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in atrial fibrillation, May 202, NICETA26: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism NICE TA287: Rivaroxaban for treating pulmonary embolism (PE) and preventing recurrent venous thrmoboembolism (VTE) Produced by Hertfordshire Pharmacy and Medicines Optimisation Team Hertfordshire, Bedfordshire and Luton Commissioning Support Central Eastern Commissioning Support Unit This HMMC recommendation is based upon the evidence available at the time of publication. The recommendation will be reviewed upon request in the light of new evidence becoming available.

3 Further information on use of Rivaroxaban in Atrial Fibrillation Algorithm for the use of Warfarin and vel Oral Anticoagulants (NOACs) for nonvalvular Atrial Fibrillation Algorithm adapted from Health Improvement Board Scotland On balance of risks and benefits, warfarin remains the anticoagulant of choice for moderate or high risk atrial fibrillation patients Is the patient currently taking warfarin? (Existing patient) Is the patient complying with their warfarin regimen? (Assess after 3 months of therapy) Make efforts to improve compliance. If non-compliance** is still a concern assess risk and consider stopping. If warfarin is stopped due to intolerable side effects, consider NOAC. New patient Does the patient with nonvalvular atrial fibrillation have a CHADS 2 2? Review the individual patient and their stroke (CHADS 2 ) and bleeding risk (HAS-BLED). Have risk and benefits of treatments been discussed with patient? Does the patient have good INR control (determined by clinical judgement, no extreme INR variations or time in treatment range [TTR] > 65% [where INR monitoring software is available])? Is warfarin tolerated? Aspirin to be considered for patients with CHADS 2 score of 0-, unless cardiologist gives rationale for anticoagulation Prescribe in line with patient selection criteria (page 5) Continue on warfarin Consider prescribing apixaban, dabigatran or rivaroxaban in patients: With poor INR control despite evidence that they are complying to treatment With intolerance to warfarin NB: All anticoagulants increase the risk of bleeding ** n- compliance: n-compliance with warfarin is not an indication for initiating therapy with NOACs. Many of the causes of non-compliance with warfarin may also result in non-compliance with NOACs, e.g. alcoholism, chaotic lifestyle, wilful non-compliance. Regular clinical review of patients on NOACs is very important especially as such patients will not be monitored routinely. See prescribing guidance with respect to monitoring BMJ learning modules on anti-coagulation warfarin &page=0 warfarin &page=0

4 Choice of appropriate anticoagulant The decision about whether to start treatment with a NOAC should be made after an informed discussion between the clinician and the patient about the risks and benefits of anticoagulants, and in particular NOACs compared with warfarin. For people who are taking warfarin, the potential risks and benefits of switching to a NOAC should be considered in light of their level of international normalised ratio (INR) control. Individual stroke risk and bleeding risk must be assessed using the CHADS 2 and HASBLED CHADS 2 scoring system HAS-BLED bleeding risk score Risk Factor Score if Risk Factor Score present Congestive heart failure (C ) Uncontrolled hypertension (systolic > 60mmHg, unresponsive to anti-hypertensives) Hypertension (H) Renal disease (dialysis, transplant, Cr>2.3mg/dl or > 200 umol/l) Age 75yrs (A) Liver disease? (cirrhosis; bilirubin >2xnormal in association with AST/ALT/ALP >3x normal) Diabetes mellitus (D) Previous history of stroke Prior stroke or TIA (S 2) 2 Prior major bleeding (anaemia or predisposition to bleeding? Total Score: Age 65 Medication usage predisposing to bleeding? (anti-platelets, NSAIDs,etc) Alcohol intake (consuming 8 or more alcoholic drinks per week) Labile INRs (refers to unstable INRs/ high INRs or poor time in NB: Where HAS-BLED score is high, prescribers therapeutic range (e.g. TTR<60%). may want to seek guidance from specialists on Total score whether anticoagulation is in the best interest of the patient. A HAS-BLED score of >3 indicates an increased one-year bleed risk on anticoagulation which would be sufficient to justify caution or more frequent evaluation. Where a patient scores point for labile INR, a score of >4 would indicate a need for caution. Interpretation of stroke risk using CHADS 2 score Interpretation of bleeding risk using HAS-BLED score CHADS 2 score Annual stroke rate (%) HAS-BLED score Bleeds/00 patients

5 . Patients with non-valvular atrial fibrillation who meet the criteria for anticoagulation but are currently not anticoagulated (i.e. newly diagnosed patients or existing patients in whom an oral anticoagulant is indicated but not currently prescribed). Where the bleeding risk is higher (using HASBLED) than the stroke rate, do not start anticoagulation without first consulting a specialist. WARFARIN REMAINS A SUITABLE FIRST-LINE ORAL ANTICOAGULANT FOR MOST PATIENTS... Warfarin is the only option in patients: with CrCl < 5ml/min or other absolute contraindications to NOAC. te that: Dabigatran is contra-indicated at CrCl <30ml/min Rivaroxaban is contra-indicated at CrCl <5ml/min, AND Rivaroxaban dose should be reduced to 5mg once daily at CrCl 5-49ml/min Apixaban is contra-indicated at CrCl<5ml/min AND Apixaban dose should be reduced in patients with at least two of the following: age 80 years, body weight 60 kg, or serum creatinine.5 mg/dl (33 micromol/l). Patients with creatinine clearance 5-29 ml/min should also receive the lower dose of apixaban 2.5 mg twice daily...2 Warfarin may be the preferred option in patients: with CrCl < 30 ml/min (NB Patients with a baseline CrCl of ml/min are at risk or progressive/acute renal dysfunction and the potential risks of bleeding with NOACs should be weighed on an individual basis) with a history of significant peptic ulcer disease significant ischaemic heart disease in absence of other determining considerations Where a specialist advises a NOAC in these categories a clear rationale will be provided...3 A NOAC may be the preferred initial option in patients: predicted to be difficult to maintain in therapeutic range on warfarin because of the need for recurrent need for interacting medications e.g. recurrent antibiotics with known excess use of ethanol (NB: patient compliance to treatment must be checked) who require domiciliary testing with a very high risk of stroke e.g. CHADS 2 score of 3 or more where rapid anticoagulation is considered clinically necessary by specialists (except where.. applies - where warfarin is the only choice; or..2 applies, where warfarin is the preferred choice). NB: Risk versus the benefit must be discussed with patients and clear rationale given to GPs In patients whose relative stroke risk is the same as their bleeding risk (using HASBLED score) dabigatran 0mg bd dosing or apixaban could be considered...4. A NOAC is the preferred option in patients: with a known sensitivity or serious side effect with warfarin which has lead to discontinuation in the past. in whom resistance to warfarin therapy has been shown in the past (inability to get INR into therapeutic range despite high doses of warfarin) which has lead to warfarin discontinuation Warfarin is recommended as the first line treatment in all other patients. The discussion with the patient should include the following factors, to explain why this decision is being made on the grounds of safety as well as cost effectiveness: lack of long term data on NOACs issues concerning reversibility NICE guidance and evidence base for apixaban/dabigatran /rivaroxaban non-compliance in clinical trial setting and its implications for those not in trials principles used in patient selection patient will be converted to NOAC if TTR < 65% after 3 months in presence of compliance higher cost of NOACs

6 ..6 When patient is referred from cardiology department with planned cardioversion Dabigatran will be initiated by a cardiologist. There is currently no data on apixaban or rivaroxaban in cardioversion. Clear advice on dose and duration of treatment will be provided to the GP. Anticoagulant service will see patient within 5 working days to perform counselling, registration etc (as above) Dabigatran should be given for 4 weeks before cardioversion and be continued for 4 weeks after cardioversion. Patients will be reviewed in cardiology outpatient department 4-6 weeks post cardioversion. It is recommended that further anticoagulant choice, if cardioversion fails, is in line with these guidelines..2 Existing patients taking warfarin for non-valvular atrial fibrillation WARFARIN REMAINS A SUITABLE FIRST-LINE ORAL ANTICOAGULANT FOR MOST PATIENTS..2. Conversion to NOAC recommended for patients: intolerant of vitamin K antagonists (VKA) resistant to the effects of warfarin (failure to get into the therapeutic range despite dose escalation) TTR < 65% after > 3 months (despite good compliance with warfarin).2.2 Conversion to NOAC may be considered for patients: with history of significant bleed on warfarin (dabigatran 0mg bd or apixaban) requiring domiciliary phlebotomy.2.3 Conversion to dabigatran 50mg bd or apixaban* may be considered in patients with history of stroke or TIA in the last 3 months, whilst taking warfarin despite good compliance, after assessing bleeding risk in relation to stroke risk. * Dabigatran 50mg bd and apixaban have been shown in clinical trials to reduce stroke risk more than warfarin. This additional benefit is dependent upon the degree of INR control in the warfarin group..2.4 Other patients who are well controlled and tolerant of warfarin are NOT recommended to change

Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:

Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban

More 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

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

Anticoagulants in Atrial Fibrillation

Anticoagulants in Atrial Fibrillation Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives

More information

TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation

TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation Service Notification in response to DHSSPS endorsed NICE Technology Appraisals TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation 1 Name of Commissioning

More information

NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation

NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation Service Notification in response to DHSSPS endorsed NICE Technology Appraisals NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation 1

More information

Dorset Cardiac Centre

Dorset Cardiac Centre P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February

More information

Updates to the Alberta Human Services Drug Benefit Supplement

Updates to the Alberta Human Services Drug Benefit Supplement Updates to the Alberta Human Services Drug Benefit Supplement Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone

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

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

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

Updates to the Alberta Drug Benefit List. Effective January 1, 2016

Updates to the Alberta Drug Benefit List. Effective January 1, 2016 Updates to the Alberta Drug Benefit List Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone Number: (780)

More information

Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options?

Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options? Patient decision aid Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options? http://guidance.nice.org.uk/cg180/patientdecisionaid/pdf/english Published: June 2014 About

More information

NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION

NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION Version 3 August 2014 NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION Dorset CCG commissions the use of newer oral anti-coagulants in accordance

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

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

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016 Version 1.4 EQIA Yes 01/06/2012

More information

All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation

All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation October 2013 This report has been prepared by a multiprofessional collaborative group, with support

More information

GRASP-AF Coming to a PCT near you.

GRASP-AF Coming to a PCT near you. GRASP-AF Coming to a PCT near you. ADAS Anticoagulation dosing advisory service Blackpool Teaching Hospitals Trust Sean O'Brien; Anticoagulation Specialist BMS Grasp-AF and the implications on our Anticoagulation

More information

An Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban)

An Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Sabiha Fatima Hussaini Sabiha.hussaini@salisbury.nhs.uk An Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) April

More information

Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM

Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM This report was commissioned by the NIHR HTA Programme as project number 12/78

More 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

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization MEDICAL ASSISTANCE HBOOK PRI AUTHIZATION OF PHARMACEUTICAL SERVICES I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants

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

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

Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation.

Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation. South West Essex Rivaroxaban Shared Care Guideline (SCG) Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation. Introduction

More information

Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants

Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants Traffic light classification- Amber 2 Information sheet for Primary Care Prescribers Relevant Licensed Indications

More information

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1

More information

Introduction. Background to this event. Raising awareness 09/11/2015

Introduction. Background to this event. Raising awareness 09/11/2015 Introduction Primary Care Medicines Governance HSCB Background to this event New class of medicines Availability of training Increasing volume of prescriptions Reports of medication incidents Raising awareness

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

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

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY Measure #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,

More information

Appendix C Factors to consider when choosing between anticoagulant options and FAQs

Appendix C Factors to consider when choosing between anticoagulant options and FAQs Appendix C Factors to consider when choosing between anticoagulant options and FAQs Choice of anticoagulant for non-valvular* atrial fibrillation: Clinical decision aid Patients should already be screened

More information

Hertfordshire guidelines for oral anticoagulation of patients with non-valvular AF

Hertfordshire guidelines for oral anticoagulation of patients with non-valvular AF Hertfordshire guidelines for oral anticoagulation of patients with non-valvular AF *GUIDELINES FOR ORAL ANTICOAGULATION OF PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION (AF) TO PREVENT STROKE Contents

More information

TSOAC Initiation Checklist

TSOAC Initiation Checklist Task Establish appropriate dose based on anticoagulant selected, indication and patient factors such as renal function. Evaluate for medication interactions that may necessitate TSOAC dose adjustment.

More information

NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST

NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST NGAIRE IS 70 YEARS OLD AND IN AF. SHE HAS NO MURMURS, NORMAL BLOOD PRESSURE, EGFR OF 65ML/MIN AND NO SIGNIFICANT PAST MEDICAL HISTORY. REGARDING

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

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND: STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention

More information

Birmingham, Sandwell and Solihull Cardiac and Stroke Network. Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement

Birmingham, Sandwell and Solihull Cardiac and Stroke Network. Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement Birmingham, Sandwell and Solihull Cardiac and Stroke Network Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement Introduction This guidance informs prescribers and commissioners

More information

NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues

NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues Andy Hutchinson Medicines Education Technical Adviser NICE Medicines and Prescribing Centre Note: this is

More information

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 06/06/2012 Review Date 06/06/2014 Version 1.1 EQIA Yes /

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

Executive Summary. Motive for the request for advice

Executive Summary. Motive for the request for advice Executive Summary Motive for the request for advice Currently nearly 400,000 people in the Netherlands are being treated with anticoagulants of a type Vitamin K antagonists (VKAs). Although VKAs are very

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

Newer Anticoagulants and Newer Diabetic Drug Classes. Nicole N. Nguyen, PharmD Senior Clinical Pharmacist Health Care Services August 21, 2013

Newer Anticoagulants and Newer Diabetic Drug Classes. Nicole N. Nguyen, PharmD Senior Clinical Pharmacist Health Care Services August 21, 2013 Newer Anticoagulants and Newer Diabetic Drug Classes Nicole N. Nguyen, PharmD Senior Clinical Pharmacist Health Care Services August 21, 2013 Apixaban Newer Anticoagulants Dabigatran etexilate Rivaroxaban

More information

Optimizing Anticoagulation Selection for Your Patient. C. Andrew Brian MD, FACC NCVH 2015

Optimizing Anticoagulation Selection for Your Patient. C. Andrew Brian MD, FACC NCVH 2015 Optimizing Anticoagulation Selection for Your Patient C. Andrew Brian MD, FACC NCVH 2015 Who Needs to Be Anticoagulated and What is the Patient s Risk? 1. Atrial Fibrillation ( nonvalvular ) 2. What regimen

More information

UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient

UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient Guidelines for Anticoagulation Initiation and Management Y2014 UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient Topic Page Number MEDICATION FLOW AND PATIENT FLOW... 2 AND 3 PARENTERAL ANTICOAGULANTS...

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

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

Anticoagulant therapy

Anticoagulant therapy Anticoagulation: The risks Anticoagulant therapy 1990 2002: 600 incidents reported 120 resulted in death of patient 92 deaths related to warfarin usage 28 reports related to heparin usage Incidents in

More information

AHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation

AHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation AHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation A Statement for Healthcare Professionals from the American Heart Association/American Stroke

More information

Hot Line Session at European Society of Cardiology (ESC) Congress 2014:

Hot Line Session at European Society of Cardiology (ESC) Congress 2014: Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Hot Line Session at European Society of Cardiology (ESC) Congress 2014: Once-Daily

More information

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease 1 Cardiovascular Disease 1. More target specific oral anticoagulants (TSOAC) 2. Vorapaxar (Zonivity) 3. Continued noise about a polypill 4. WATCHMAN 3 1 2 3 4 Left Atrial Appendage

More information

NORTH WEST LONDON GUIDANCE ANTITHROMBOTIC MANAGEMENT OF ATRIAL FIBRILLATION

NORTH WEST LONDON GUIDANCE ANTITHROMBOTIC MANAGEMENT OF ATRIAL FIBRILLATION North West London CardioVascular & Stroke Network NORTH WEST LONDON GUIDANCE ON ANTITHROMBOTIC MANAGEMENT OF ATRIAL FIBRILLATION Key Messages 1. Efforts should be made to identify patients with Atrial

More information

NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS

NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS Date of First Issue 01/12/ 2012 Approved 15/11/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016

More information

New Real-World Evidence Reaffirms Low Major Bleeding Rates for Bayer s Xarelto in Patients with Non-Valvular Atrial Fibrillation

New Real-World Evidence Reaffirms Low Major Bleeding Rates for Bayer s Xarelto in Patients with Non-Valvular Atrial Fibrillation Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Late-Breaking Science at ESC Congress 2015: New Real-World Evidence Reaffirms

More information

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep

More information

Version 8, 25 April 2013

Version 8, 25 April 2013 Hertfordshire Implementation of NICE TAs 249, 256 and 275 Apixaban, dabigatran and rivaroxaban, novel oral anticoagulants (NOACs) for the prevention of stroke and systemic embolism in non-valvular atrial

More information

NWMIC Medicines FAQ. New oral anticoagulants (NOACs) and management of dental patients - Dabigatran, rivaroxaban and apixaban.

NWMIC Medicines FAQ. New oral anticoagulants (NOACs) and management of dental patients - Dabigatran, rivaroxaban and apixaban. NWMIC Medicines FAQ New oral anticoagulants (NOACs) and management of dental patients - Date prepared: May 2013, updated November 2013 Summary In primary care; Consider liaising with the local hospital

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

Anticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk

Anticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk Anticoagulation at the end of life Rhona Maclean Rhona.maclean@sth.nhs.uk Content Anticoagulant Therapies Indications for anticoagulation Venous thromboembolism (VTE) Atrial Fibrillation Mechnical Heart

More 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

NIL. Dr Chuks Ajaero FMCP FRACP Cardiologist QEH, NALHN, SA Heart & Central Districts. Approach. Approach. 06-Nov-14

NIL. Dr Chuks Ajaero FMCP FRACP Cardiologist QEH, NALHN, SA Heart & Central Districts. Approach. Approach. 06-Nov-14 Stroke Prevention in Atrial Fibrillation: Commencing Non- Oral Anticoagulants in GP setting Dr Chuks Ajaero FMCP FRACP Cardiologist QEH, NALHN, SA Heart & Central Districts Disclosures NIL Classification

More information

PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline

PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline The aim of this document to guide clinicians on use of novel anticoagulants for stroke

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants which meet any of the following conditions

More information

Implementation of NICE TAs 261 and 287

Implementation of NICE TAs 261 and 287 Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group Northampton General Hospital NHS Trust Northamptonshire Healthcare Foundation Trust Implementation

More 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

EMA Reaffirms Positive Benefit-Risk Balance of Bayer s Xarelto for Stroke Prevention in Patients with Atrial Fibrillation

EMA Reaffirms Positive Benefit-Risk Balance of Bayer s Xarelto for Stroke Prevention in Patients with Atrial Fibrillation Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com EMA Reaffirms Positive Benefit-Risk Balance of Bayer s Xarelto for Stroke Prevention

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

NOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions

NOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions AC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions FAQ document jointly prepared by NHSGGC Haematology Service & Medicines Infmation On behalf of the Heart MCN

More information

Bayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention

Bayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Long-term prevention of venous blood clots (VTE): Bayer Initiates Rivaroxaban

More information

Objectives of Session

Objectives of Session Objectives of Session Project Background Why the need Decision Support Tool summary of key evidence Promotion Key Messages Project Background Grasp AF Audit Initial Grasp AF project undertaken in NHS Buckinghamshire

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

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

Prevention of stroke in patients with atrial fibrillation

Prevention of stroke in patients with atrial fibrillation www.sign.ac.uk Prevention of stroke in patients with atrial fibrillation A guide for primary care January 2014 Evidence Contents 1 Introduction... 1 2 Detection...2 3 Risk stratification... 3 4 Treatment

More information

Bridging the Gap: How to Transition from the NOACs to Warfarin

Bridging the Gap: How to Transition from the NOACs to Warfarin Bridging the Gap: How to Transition from the NOACs to April 24 th 2015 UAN: 0048-0000-15-034-L01-P Amanda Styer, Pharm.D. Marion General Hospital, OhioHealth Objectives: 1. Review labeling regarding transition

More information

2. Background This indication of rivaroxaban had not previously been considered by the PBAC.

2. Background This indication of rivaroxaban had not previously been considered by the PBAC. PUBLIC SUMMARY DOCUMENT Product: Rivaroxaban, tablets, 15mg and 20mg, Xarelto Sponsor: Bayer Australia Ltd Date of PBAC Consideration: March 2013 1. Purpose of Application The application requested the

More information

Service Specification Template Department of Health, updated June 2015

Service Specification Template Department of Health, updated June 2015 Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st

More information

Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF

Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Leeds Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your

More information

VOLUME No: 21 04 written by Sara Wilds & Kathryn Buchanan. Date of issue: June 2012 (updated November 2012 following NICE TA 256)

VOLUME No: 21 04 written by Sara Wilds & Kathryn Buchanan. Date of issue: June 2012 (updated November 2012 following NICE TA 256) Prescribing Points A NEWSLETTER FOR ALL HEALTH CARE PROFESSIONALS IN OXFORDSHIRE, WRITTEN BY THE MEDICINES MANAGEMENT TEAM, OXFORDSHIRE PCT, JUBILEE HOUSE, OXFORD BUSINESS PARK SOUTH, OXFORD, OX4 2LH.

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

Anticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions

Anticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions Anticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions What is atrial fibrillation?...2 What are dabigatran, rivaroxaban and apixaban and what are they used for?...2

More information

22-Oct-14. Oral Anticoagulation Which Drug for Which Patient in the era of New Oral Anti-coagulants. Atrial Fibrillation. AF as an embolic risk factor

22-Oct-14. Oral Anticoagulation Which Drug for Which Patient in the era of New Oral Anti-coagulants. Atrial Fibrillation. AF as an embolic risk factor Oral Anticoagulation Which Drug for Which Patient in the era of New Oral Anti-coagulants Dr Scott McKenzie BSc MBBS FRACP FCSANZ Cardiologist, Vascular Physician, Telehealth Specialist, Advanced Heart

More information

Medicines Management Programme. Oral anticoagulants for stroke prevention in non-valvular atrial fibrillation

Medicines Management Programme. Oral anticoagulants for stroke prevention in non-valvular atrial fibrillation Medicines Management Programme Oral anticoagulants for stroke prevention in non-valvular atrial fibrillation Drugs in this review include: Warfarin Apixaban Dabigatran Rivaroxaban Approved by Prof. Michael

More information

Drug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients.

Drug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients. Drug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients. DOCUMENT TO BE SCANNED INTO ELECTRONIC RECORDS AS AND FILED IN NOTES Patient Name : Date of Birth:

More information

I NUOVI ANTICOAGULANTI ORALI

I NUOVI ANTICOAGULANTI ORALI AGGIORNAMENTI in CARDIOLOGIA I NUOVI ANTICOAGULANTI ORALI F. BELLANDI U.O.CARDIOLOGIA OSPEDALE DI PRATO NOVEL ORAL ANTICOAGULANTS RISK SCORE STRATIFICATION TRULY LOW RISK PATIENTS CHA 2 DS 2 -VASc vs

More information

Stroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2

Stroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2 Bleeding/Clotting Risk Evaluation Tools for Atrial Fibrillation Patients Before prescribing anticoagulants, providers should weigh the risk of thrombosis against the risk of bleeding. The tools below can

More information

Atrial Fibrillation An update on diagnosis and management

Atrial Fibrillation An update on diagnosis and management Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.

More information

Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation

Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation Issued: May 2012 guidance.nice.org.uk/ta256 NICE has accredited the process used by the Centre for Health

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

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your

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

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

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

Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com. News Release. Not intended for U.S. and UK Media

Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com. News Release. Not intended for U.S. and UK Media News Release Not intended for U.S. and UK Media Bayer Pharma AG 13342 Berlin Germany Tel. +49 30 468-1111 www.bayerpharma.com Bayer Forms Collaboration with Academic and Governmental Institutions for Rivaroxaban

More information

Rivaroxaban for the treatment of Deep Vein Thrombosis in patients unsuitable for vitamin K antagonists

Rivaroxaban for the treatment of Deep Vein Thrombosis in patients unsuitable for vitamin K antagonists Rivaroxaban for the treatment of Deep Vein Thrombosis in patients unsuitable for vitamin K antagonists Traffic light classification- Amber 2 specialist initiation Information sheet for Primary Care Prescribers

More information

Implementation of NICE TA 249, 256, and 275

Implementation of NICE TA 249, 256, and 275 Dabigatran, rivaroxaban and apixaban, the new oral anticoagulants (NOACS), for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation Implementation of NICE TA 249, 256, and

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