Disclosure: Dr. Smith has no actual or potential conflict of interest associated with this presentation.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Disclosure: Dr. Smith has no actual or potential conflict of interest associated with this presentation."

Transcription

1 Disclosure: Dr. Smith has no actual or potential conflict of interest associated with this presentation. Michael Smith, Pharm. D., BCPS, CACP Pharmacy Clinical Manager William Backus Hospital You were just diagnosed with atrial fibrillation. What drug are you going to use? A. Dabigatran B. Rivaroxaban C. Warfarin D. Um, no thanks, I don t want to bleed to death! One snowy morning in February, 1933, Ed Carlson, a farmer from Deer Park, Wisconsin, came into Karl Paul Link's laboratory carrying a milk can full of blood that refused to coagulate. Outside he had a small heap of spoiled sweet clover hay and a dead heifer freezing in the back of his truck. 1

2 Discuss the mechanism of action, indications, contraindications and adverse effects. Discuss the available monitoring and reversibility of these agents. Identify patients that may benefit from the new agents and those that may not. Ideal Anticoagulant Oral and Injectable Rapid onset/off Effective on venous and arterial thrombosis Rapidly reversible No monitoring necessary, but possible No drug interactions No or predictable effects of renal/hepatic disease Intrinsic system Extrinsic system (surface contact) (tissue damage) XII XIIa Tissue factor XI XIa IX IXa VIIa VII Unfractionated heparin 2,3 VIII VIIIa X Low molecular-weight heparins 2,3 Xa Vitamin K antagonists 4 V Va Direct thrombin inhibitors 4,5 II IIa (Thrombin) Factor Xa inhibitors 4,5 Fibrinogen Fibrin Dabigatran Rivaroxaban Apixaban Medical MAGELLAN ADOPT Prophylaxis THA RE NOVATE RECORD I RECORD II ADVANCE 3 TKA VTE Treatment RE MOBILIZE RE MODEL RE MEDY RE COVER RE SONATE RECORD III RECORD IV EINSTEIN DVT EINSTEIN PE EINSTEIN EXT ADVANCE 1 ADVANCE 2 AMPLIFY AMPLIFY EXT 1. Adapted from Petitou M et al. Nature. 1991;350(6319 suppl): Hirsh J, Fuster V. Circulation. 1994;89: Hirsh J et al. Chest. 2001;119(1 suppl):64s-94s. 4. Nutescu EA et al. Pharmacotherapy. 2004;24(7 Pt 2):82S-87S. 5. Bauer KA. J Thromb Thrombolysis. 2006;21: Atrial Fibrillation Acute Coronary Syndrome Heart Valve replacement Dabigatran Rivaroxaban Apixaban RE LY ROCKET ARISTOTLE RE DEEM (phase II) RE ALIGN (phase II) ATLAS TIMI 46 ATLAS TIMI 51 APPRAISE (phase II) Direct thrombin inhibitor (DTI) Indication: Reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Dose For CrCl>30 ml/min: 150mg BID For CrCl 15 30ml/min: 75mg BID 80% renal elimination Prescribing information, Boehringer Ingelheim Pharmaceuticals,

3 RE LY trial 18,113 patients with atrial fibrilliation, unblinded warfarin use, 110mg or 150mg dabigatran, non inferiority, TTR = 64%. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalized ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trail. Lancet Sep 18;376(9745): Outcome (%/yr) Dabigatran Warfarin Relative Risk P value Stroke or systemic embolism ( ) 0.01 Death from any cause ( ) Major Bleeding ( ) 0.31 Anything bad ( ) 0.04 Conelly, SJ. N Engl J Med 2009;361: Warnings and Precautions Dabigatran therapy should be temporarily discontinued before invasive or surgical procedures to decrease bleeding risk. Dabigatran should be discontinued 1 to 2 days (if CrCl is 50 ml/min or greater) or 3 to 5 days (if CrCl is less than 50 ml/min) before invasive or surgical procedures. Consider a longer period without the drug in patients undergoing major surgery, spinal puncture, or placement of a spinal or epidural catheter or port. P glycoprotein (PgP) inducers and inhibitors may affect dabigatran pharmacokinetics. Coadministration of rifampin, a PgP inducer, should be avoided because it reduces dabigatran exposure. AUC increase with amiodarone (12%), quinidine (53%), verapamil (23%), ketoconazole (150%). Adverse Drug Reactions The most common adverse reactions, occurring in at least 15% of patients receiving dabigatran to reduce the risk of stroke in atrial fibrillation, are gastritis like symptoms (35% with dabigatran and 24% with warfarin) and bleeding. In the RE LY study, major bleeding occurred in 3.3% of patients treated with dabigatran and 3.6% of patients treated with warfarin. Bleeding of any kind occurred in 16.6% of patients treated with dabigatran and 18.4% of patients treated with warfarin. Wallentin L. Lancet Sep 18;376(9745): Prescribing information, Boehringer Ingelheim Pharmaceuticals, 2012 FDA Drug Safety Communication: Safety review of post market reports of serious bleeding events with the anticoagulant Pradaxa (dabigatran etexilate mesylate) : The U.S. Food and Drug Administration (FDA) is evaluating post marketing reports of serious bleeding events in patients taking Pradaxa (dabigatran etexilate mesylate). Pradaxa is a blood thinning (anticoagulant) medication used to reduce the risk of stroke in patients with non valvular atrial fibrillation (AF), the most common type of heart rhythm abnormality. Is renal function to blame? Renal Function CrCl (ml/min) Increase in AUC Increase in C max T1/2 (h) Normal 80 1 X 1 X 13 Mild X 1.1 X 15 Moderate X 1.7 X 18 Severe* X 2.1 X 27 Patients with severe renal impairment were not studied in RE LY. Dosing recommendations in subjects with severe renal impairment are based on pharmacokinetic modeling 75 mg dose was never clinically studied! Prescribing information, Boehringer Ingelheim Pharmaceuticals,

4 Never mind... FDA Drug Safety Communication: Update on the risk for serious bleeding events with the anticoagulant Pradaxa The U.S. Food and Drug Administration (FDA) has evaluated new information about the risk of serious bleeding associated with use of the anticoagulants (blood thinners) dabigatran (Pradaxa) and warfarin (Coumadin, Jantoven, and generics). Following the approval of Pradaxa, FDA received a large number of post marketing reports of bleeding among Pradaxa users. As a result, FDA investigated the actual rates of gastrointestinal bleeding (occurring in the stomach and intestines) and intracranial hemorrhage (a type of bleeding in the brain) for new users of Pradaxa compared to new users of warfarin. The results of this Mini Sentinel assessment indicate that bleeding rates associated with new use of Pradaxa do not appear to be higher than bleeding rates associated with new use of warfarin, which is consistent with observations from the large clinical trial used to approve Pradaxa (the RE LY trial) Direct factor Xa inhibitor Half life 5 9hrs Dose 10mg, 15mg, 20mg depending on indication, point in therapy, and renal function. 65% renal elimination Healthcare professionals who prescribe Pradaxa should carefully follow the dosing recommendations in the drug label, especially for patients with renal impairment (when kidneys don t function normally) to reduce the risk of bleeding. Prescribing information, Janssen Pharmaceuticals, 2011 Indication To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation For the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery. For the treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and of PE Dosage For patients with CrCl >50 ml/min: 20 mg orally, once daily with the evening meal For patients with CrCl ml/min: 15 mg orally, once daily with the evening meal Hip: 10 mg orally, once daily for 35 days Knee: 10 mg orally, once daily for 12 days 15 mg orally twice daily with food for the first 21 days for the initial treatment. After the initial treatment period, 20 mg orally once daily for the remaining treatment period. ROCKET AF trial 14,264 patients, double blind, Rivaroxaban 20mg daily vs warfarin, non inferiority, 55% TTR Outcome (%/yr) Rivaroxaban Warfarin Hazard ratio P value Stroke or systemic ( ) <0.00 embolism Death from any cause ( ) 0.15 Major Bleeding ( ) 0.58 Anything bad?? Prescribing information, Janssen Pharmaceuticals, 2011 Patel MR. N Engl J Med 2009;361: RECORD trials Randomized, double blind, thromboprophylaxis of orthopedic surgery Rivaroxaban 10mg PO Daily vs Enoxaparin; rivaroxaban started 6 8hrs after surgery RECORD-1 RECORD-2 RECORD-3 RECORD-4 Population THR n=4541 THR n=2509 TKA n=2531 TKA n=3148 Comparator Enoxaparin 40mg Daily Enoxaparin 40mg Daily Enoxaparin 40mg Daily Enoxaparin 30mg BID Duration 35 days Riva- 35 days Enox- 10 days 14 days 14 days VTE events Major Bleeding 1.1% Rivarox 3.7% Enox 0.3% Rivarox 0.1% Enox 2% Rivarox 9.3% Enox 9.6% Rivarox 18.9% Enox <0.1% 0.6% Rivarox 0.5% Enox 6.9% Rivarox 10.1% Enox 0.7% Rivarox 0.3% Enox Eriksson NEJM. 2008;358: Kakkar Lancet. 2008;372:31-39 Lassan NEJM. 2008;358: Turpie Lancet. 2009;373(9676): EINSTEIN DVT and EINSTEIN PE trials Treatment of VTE and the long term prevention of VTE. Open label, non inferiority study. Patients received rivaroxaban 15 mg twice daily for 3 weeks followed by 20 mg once daily for 3, 6, or 12 months, or Enoxaparin 1 mg/kg twice daily followed by warfarin or an acenocoumarol dose adjusted to an international normalized ratio (INR) of 2 to 3 for 3, 6, or 12 months. DVT TTR 57.7%; PE TTR 62.7% Outcome % Rivaroxaban Warfarin Hazard Ratio P value DVT RecurrentVTE ( ) <0.001 DVT Bleeding PE RecurrentVTE ( ) PE Bleeding ( ) 0.23 N Engl J Med 2010;363: N Engl J Med 2012;366:

5 Contraindications: Rivaroxaban therapy is contraindicated in patients with known allergy to rivaroxaban or any of the product ingredients, and in patients with active major bleeding. Warnings and Precautions: Avoid the use of in patients with CrCl <15 ml/min since drug exposure is increased. Treatment of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Reduction in the Risk of Recurrence of DVT and of PE and Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: Avoid the use in patients with CrCl <30 ml/min due to an expected increase in rivaroxaban exposure and pharmacodynamic effects in this patient Population. Drug Interactions: Rivaroxaban is a substrate of CYP3A4/5, P glycoprotein (P gp); concomitant use of rivaroxaban with combined P gp and strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, lopinavir/ritonavir, ritonavir, indinavir/ritonavir, conivaptan) should be avoided. Concomitant use of rivaroxaban with combined P gp and weak or moderate CYP3A4 inhibitors (eg, erythromycin, azithromycin, diltiazem, verapamil, quinidine, ranolazine, dronedarone, amiodarone, felodipine) should be avoided in patients with renal impairment, unless the benefit outweighs the bleeding risk. Concomitant use of rivaroxaban with combined P gp and strong CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, St. John s wort) should be avoided, or consideration given to use of an increased rivaroxaban dose. Administration with rifampicin resulted in a 50% reduction in rivaroxaban AUC and a 22% reduction in the rivaroxaban Cmax, with accompanying reductions in rivaroxaban effects. Prescribing information, Janssen Pharmaceuticals, 2011 ROCKET AF Discussion Event rates were similar at 30 days and 1 year after withdrawal, suggesting that the mechanism of events did not involve hypercoagulability early after withdrawal of rivaroxaban. Events occurring at the end of the study were probably related to increased difficulty in achieving the transition from blinded trial therapy to the open label use of a vitamin K antagonist when the patient had previously been assigned to the rivaroxaban group, since presumably many patients who had previously been assigned to the warfarin group would have already had a therapeutic INR. Prescribing information, Janssen Pharmaceuticals, 2011 Patel MR. N Engl J Med 2009;361: Rivaroxaban is rapidly replacing warfarin and enoxaparin to reduce the risk of pulmonary and venous thromboembolism after hip and knee surgery. When we examined the reports, we found that the primary event was not hemorrhage, as with other anticoagulants. Instead, the largest category of events (158 cases, 44.4% of the total) was serious thrombus, most often pulmonary embolism the very event rivaroxaban is intended to prevent. As might be expected, there were also numerous reports of hemorrhage (121 cases, 34% of the total). Direct factor Xa inhibitor Indication: To reduce the risk of stroke and systemic embolism in patients with nonvlvular atrial fibrillation.* Dose: 5mg BID Renal elimination 25% * Proposed indication Press release, Bristol-Myers Squibb, 9/26/2012 5

6 FDA decision due on 3/28/12, 3/17/13 Originally granted a priority review by the FDA A priority review designation is given to drugs that offer major advances in treatment, or provide a treatment where no adequate therapy exists. ARISTOTLE Trial 18,201 patients, double blind, apixaban 5mg BID vs warfarin, non inferiority, 62.2% TTR Outcome (%/yr) Apixaban Warfarin Hazard ratio P value Stroke or systemic embolism ( ) 0.01* Death from any cause ( ).047 Major Bleeding ( ) <0.001 Anything bad ( ) <0.001 Press release, Bristol-Myers Squibb, 9/26/2012 *p value for superiority! Granger CB. N Engl J Med. 2011;365(11): Warnings, precautions, side effects. Metabolized by CYP 3A4 TBD You were just diagnosed with atrial fibrillation. What drug are you going to use? A. Dabigatran B. Rivaroxaban C. Apixaban D. Warfarin. Um, no thanks, I don t want to bleed to death! You feel that A. The ability to monitor a drug is important B. Warfarin monitoring is too troublesome C. They didn t monitor in the trials, it s not necessary, so what s the big deal? D. Hey, we re past the halfway point! May be important for: Compliance determination Determining why treatment fails Drug interactions/hepatic/renal issues Hemorrhagic events Emergent surgical needs 6

7 Assay Dabigatran Rivaroxaban Apixaban PT Not really Sensitive Sensitive aptt Sensitive Not really Not really PT and aptt do not respond in a linear or predictable fashion. They are useful for testing for the presence of the drug in the plasma. Not for determination of the extent of anticoagulation. Caution when trying to test INR with concurrent warfarin use. Other tests are being developed Miyares MA. AJHP 2012;69: Warfarin Decreases production of factors II, VII, IX, X To reverse Vitamin K to overcome competitive inhibition ~4 hours Fresh frozen plasma (FFP) contains all coagulation factors in dilute amounts. Complex concentrates (PCC) contain various coagulation factors. Intrinsic system Extrinsic system (surface contact) (tissue damage) XII XIIa Tissue factor XI XIa IX IXa VIIa VII Unfractionated heparin 2,3 VIII VIIIa X Low molecular-weight heparins 2,3 Xa Vitamin K antagonists 4 V Va Direct thrombin inhibitors 4,5 II IIa (Thrombin) Factor Xa inhibitors 4,5 Fibrinogen Fibrin 1. Adapted from Petitou M et al. Nature. 1991;350(6319 suppl): Hirsh J, Fuster V. Circulation. 1994;89: Hirsh J et al. Chest. 2001;119(1 suppl):64s-94s. 4. Nutescu EA et al. Pharmacotherapy. 2004;24(7 Pt 2):82S-87S. 5. Bauer KA. J Thromb Thrombolysis. 2006;21: Prothrombin Complex Concentrates 3 Factor PCC (Bebulin VH, Profilnine SD) Contain factors II, IX, X 4 Factor PCC Available as Feiba NF in the US II, IX, X and activated VII These products are all unique with respect to concentrations of factors and considered not interchangeable. Consider external validity Clinical trials have been done either in animal models or healthy human volunteers. Mixed results with end points. Normalization of coagulation markers Normalization of bleeding time Human trials of PCCs have used agents not available in the US. Apixaban Dabigatran Rivaroxaban Oral activated No data In vitro No data Charcoal Hemodialysis No data Human volunteers No data Hemoperfusion No data In vitro No data w/charcoal Fresh frozen plasma No data Mouse No data Activated factor VIIa No data Rat Rat and Baboon 3 factor PCC No data No data No data 4 factor PCC No data Human volunteers and rats Human volunteers Katz S, Kouides PA, Garcia DA, et al. Am J Hematol. 2012;87:S141-s145. 7

8 Apixaban Dabigatran Rivaroxaban Oral activated Yes Yes Yes Charcoal Hemodialysis No Yes No Hemoperfusion Possible Yes Possible w/charcoal Fresh frozen plasma No No No Activated factor VIIa Unclear Unclear Unclear 3 factor PCC Unclear Unclear Unclear 4 factor PCC Possible Possible Possible Panel s conclusions PCC: The use of either 3 factor or 4 factor PCCs have the potential to increase the risk of thrombosis. There have been no studies evaluating the effect of PCCs on bleeding in humans receiving the new oral anticoagulants. Whether use of PCCs will be effective to stop critical bleeding or reverse the anticoagulant effects of the new agents enough to safely proceed with emergent surgery is not established but seems, given the current state of information, to be a reasonable approach in dire clinical situations in the opinion of several of the authors. Importantly, however, consensus was not reached regarding PCC, as two authors felt that PCC cannot be recommended at this time due to absence of data. Katz S, Kouides PA, Garcia DA, et al. Am J Hematol. 2012;87:S141-s145. Katz S, Kouides PA, Garcia DA, et al. Am J Hematol. 2012;87:S141-s145. With respect to reversibility, you feel A. Keep those drugs away from me until a reversal agent is available. B. Risk of severe hemorrhage is low (and possibly lower than warfarin), I m comfortable with the new agents. Things to consider: Efficacy/Safety Compliance Cost Management NEWER ORAL ANTICOAGULANTS SHOULD BE USED AS FIRST LINE AGENTS TO PREVENT THROMBOEMBOLISM IN PATIENTS WITH ATRIAL FIBRILLATION AND RISK FACTORS FOR STROKE OR THROMBOEMBOLISM Warfarin monitoring and adverse reactions are an enormous burden to the healthcare system. Convenience may lead to improved adherence and persistence. Decreased hemorrhagic stroke and intracranial bleeding. Trend towards improved mortality. Granger CB, Armaganijan LV. Circulation. 2012;125: NEWER ORAL ANTICOAGULANTS SHOULD NOT BE USED AS FIRST LINE AGENTS TO PREVENT THROMBOEMBOLISM IN PATIENTS WITH ATRIAL FIBRILLATION. RE LY trial was open label with a 21% dropout rate for dabigatran and increased major GI bleeding and MI. Vanishing difference in relative efficacy as warfarin management improved. ROCKET AF trial had only a 57.8% TTR. Increased risk with poor adherence and no consistent follow up. Drug interactions? Ansell, J. Circulation. 2012;125: Many patient factors to consider to determine which is most appropriate. Anticoagulation management service available Efficacy likely equal Poor compliance Warfarin likely better Economic issues Rx cost least with warfarin, but what about monitoring? Monitoring beneficial renal/hepatic disease, many medications/interactions Possible with warfarin High risk of bleeding events reversibility vs decreased bleeding risk What about those having poor response to warfarin? What s the problem? 8

9 You were just diagnosed with atrial fibrillation. What drug are you going to use? A. Dabigatran B. Rivaroxaban C. Apixaban D. Warfarin Um, are we done yet? 9

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

DABIGATRAN ETEXILATE TARGET Vitamin K epoxide reductase WARFARIN RIVAROXABAN APIXABAN

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

More information

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

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

More information

Management for Deep Vein Thrombosis and New Agents

Management for Deep Vein Thrombosis and New Agents Management for Deep Vein Thrombosis and New Agents Mark Malesker, Pharm.D., FCCP, FCCP, FASHP, BCPS Professor of Pharmacy Practice and Medicine Creighton University 5 th Annual Creighton Cardiovascular

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

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

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

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

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

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

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

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

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

Experience matters: Practical management in your hospital

Experience matters: Practical management in your hospital Experience matters: Practical management in your hospital Dr AGG Turpie McMaster University, Hamilton, ON, Canada Disclosures AGG Turpie has acted as a consultant for Bayer HealthCare, Janssen, Sanofi-Aventis,

More information

Rivaroxaban (Xarelto ) by

Rivaroxaban (Xarelto ) by Essentia Health Med Moment Short Video Tune-Up A brief overview of a new medication, or important new medication information Rivaroxaban (Xarelto ) by Richard Mullvain RPH BCPS (AQC) Current - August 2011

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

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

More information for patients and caregivers can be accessed at http://www.xarelto-us.com/.

More information for patients and caregivers can be accessed at http://www.xarelto-us.com/. Janssen Research & Development Submits Application to U.S. FDA for XARELTO (rivaroxaban) to Reduce Secondary Cardiovascular Events in Patients with Acute Coronary Syndrome RARITAN, DECEMBER 29, 2011 -

More information

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

The speakers have attested that their presentation will be free of all commercial bias toward a specific company and its products. Update on New Anticoagulants (Apixaban, Dabigatran and Rivaroxaban) Patient Safety Daniel B. DiCola, MD and Paul Ament,, Pharm.D Excela Heath, Latrobe, PA Disclosures: Paul Ament discloses that he receives

More information

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

Time of Offset of Action The Trial

Time of Offset of Action The Trial New Antithrombotic Agents DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant Amgen Tom DeLoughery, MD FACP FAWM Oregon Health and Sciences University What I am Talking About

More 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

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

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

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

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

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

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

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

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

Oral Anticoagulants: What s New?

Oral Anticoagulants: What s New? Oral Anticoagulants: What s New? Sallie Young, Pharm.D., BCPS (AQ-Cardiology) Clinical Pharmacy Specialist, Cardiology Penn State Hershey Medical Center syoung1@hmc.psu.edu August 2012 Oral Anticoagulant

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

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

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

News Release. Media contacts: Ernie Knewitz Tel: 908.927.2953 Mobile: 917.697.2318 eknewitz@its.jnj.com

News Release. Media contacts: Ernie Knewitz Tel: 908.927.2953 Mobile: 917.697.2318 eknewitz@its.jnj.com News Release Media contacts: Ernie Knewitz Tel: 908.927.2953 Mobile: 917.697.2318 eknewitz@its.jnj.com Shaun Mickus Phone: 908.927.2416 Mobile: 973.476.7144 smickus@its.jnj.com Investor contacts: Stan

More information

ABOUT XARELTO CLINICAL STUDIES

ABOUT XARELTO CLINICAL STUDIES ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the

More information

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

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

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

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

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

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

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

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

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

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

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

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

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

MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants

MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013 Anticoagulants Anticoagulants are agents that prevent the formation of blood clots. Before we can talk about

More information

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

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE June 22, 2015 SUBJECT EFFECTIVE DATE MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Anticoagulants Pharmacy Service Leesa M. Allen, Deputy Secretary Office of Medical

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

East Kent Prescribing Group

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

More information

New Oral Anticoagulants in the Management of Atrial Fibrillation June, 2012 By Deborah K Brokaw, Pharm.D.

New Oral Anticoagulants in the Management of Atrial Fibrillation June, 2012 By Deborah K Brokaw, Pharm.D. New Oral Anticoagulants in the Management of Atrial Fibrillation June, 2012 By Deborah K Brokaw, Pharm.D. Introduction Since the 1950 s, the only orally available anticoagulant has been the vitamin K antagonist

More information

Novel Anticoagulants

Novel Anticoagulants Novel Anticoagulants Mark T. Reding, MD Associate Professor of Medicine Division of Hematology, Oncology, and Transplantation Director, Center for Bleeding and Clotting Disorders University of Minnesota

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

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

New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther

New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis Mark Crowther 1 Disclosures Advisory Boards in last 24 months Pfizer, Alexion, Bayer, CSL Behring,

More information

The New Kids on the Block: Oral Anticoagulants

The New Kids on the Block: Oral Anticoagulants The New Kids on the Block: Oral Anticoagulants Lauren E. Odum, PharmD, BCPS Clinical Assistant Professor UMKC School of Pharmacy at MU April 11, 2014 Objectives Be able to Understand the major trials leading

More information

Laboratory Testing in Patients on Novel Oral Anticoagulants (NOACs)

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

More information

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

Rivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012

Rivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012 Rivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012 Agenda Ideal anticoagulant. Drawbacks of warfarin. Rivaroxaban in clinical trails. Present

More 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

DISCLOSURES CONFLICT CATEGORY. No conflict of interest to disclose

DISCLOSURES CONFLICT CATEGORY. No conflict of interest to disclose DISCLOSURES CATEGORY Employment Research support Scientific advisory board Consultancy Speakers bureau Major stockholder Patents Honoraria Travel support Other CONFLICT No conflict of interest to disclose

More information

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

Prior Authorization Guideline

Prior Authorization Guideline Guideline Guideline Name Formulary Xarelto (rivaroxaban) UnitedHealthcare Community & State Approval Date 0/0/203 Revision Date 8//204 Technician Note: CPS Approval Date: /5/20; CPS Revision Date: 8/20/204

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

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

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

Medication Policy Manual. Topic: Eliquis, apixaban Date of Origin: July 12, 2013. Committee Approval Date: July 11, 2014 Next Review Date: July 2015

Medication Policy Manual. Topic: Eliquis, apixaban Date of Origin: July 12, 2013. Committee Approval Date: July 11, 2014 Next Review Date: July 2015 Medication Policy Manual Policy No: dru313 Topic: Eliquis, apixaban Date of Origin: July 12, 2013 Committee Approval Date: July 11, 2014 Next Review Date: July 2015 Effective Date: August 1, 2014 IMPORTANT

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

Clinical Assistant Professor University of Kansas School of Pharmacy. Objectives

Clinical Assistant Professor University of Kansas School of Pharmacy. Objectives New Oral Anticoagulants Tiffany R. Shin, PharmD, BCACP Clinical Assistant Professor University of Kansas School of Pharmacy 1 Objectives Discuss the advantages and disadvantages of the new oral anticoagulants

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

Novel Anticoagulants

Novel Anticoagulants Novel Anticoagulants Kathleen Ozsvath, MD Associate Professor of Surgery, Albany Medical Center Partner, The Vascular Group, Albany, NY Chief of Vascular Services, Samaritan and St. Mary s Hospital, Troy,

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

Disclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU

Disclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU New Agents for Treatment of DVT Disclosure PI Adopt and Amplify trials Mark Oliver, MD, RVT, RPVI,FSVU BMS and Pfizer Speaker VTE Venous Thromboembolism Recognized DVT s New : 170,000 Recurrent : 90,000

More information

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

2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS ANTICOAGULATION UPDATE C AR R I E P AL M E R, D N P, RN, AN P - BC OBJECTIVES At the end of the presentation, the NP will be able to: Identify new indications for target-specific oral anticoagulants (TSOACs),

More information

Disclosures. Objectives 4/25/2014. Novel Anticoagulants in the Elderly

Disclosures. Objectives 4/25/2014. Novel Anticoagulants in the Elderly Novel Anticoagulants in the Elderly Bahar Matusik, PharmD, BCPS Assistant Professor Department of Pharmacy Practice & Administration University of Saint Joseph, School of Pharmacy Disclosures Dr. Bahar

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

Oral Anticoagulation in Older Persons The Next Generation

Oral Anticoagulation in Older Persons The Next Generation Oral Anticoagulation in Older Persons The Next Generation Luis Viana B.Sc. Phm., Pharm D (candidate), M.Ed., ACPR, CGP Clinical Consultant Pharmacist, Medical Pharmacies Group Limited Adjunct Clinical

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

http://www.medscape.org/viewarticle/808338_print

http://www.medscape.org/viewarticle/808338_print Page 1 of 18 From Medscape Education Cardiology Pharmacokinetics of Anticoagulants: Why It Matters Matthew A. Cavender, MD, MPH; Robert P. Giugliano, MD, SM CME Released: 07/31/2013 ; Valid for credit

More information

New Oral Anticoagulant Drugs What monitoring if any is required?

New Oral Anticoagulant Drugs What monitoring if any is required? New Oral Anticoagulant Drugs What monitoring if any is required? Michelle Williamson Supervising Scientist High Throughput Haematology Pathology Queensland PAH Laboratory Overview Background What new oral

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

indications November 2 nd, 2012 Dalhousie University

indications November 2 nd, 2012 Dalhousie University + New oral anticoagulants: A review of current indications November 2 nd, 2012 Dr. Sudeep Shivakumar, Hematology Dalhousie University + Objectives es To review indications for anticoagulation To discuss

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

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

Thrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare

Thrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare Thrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare Kenya Association of Physicians Conference 10 th May 2013 New anticoagulants:

More information

New Oral Anticoagulants for VTE, A-fib, and ACS

New Oral Anticoagulants for VTE, A-fib, and ACS New Oral Anticoagulants for VTE, A-fib, and ACS KCUMB Fall CME 2014 September 18, 2014 Schoen W. Kruse, Ph.D. Assistant Dean Associate Professor of Pharmacology KCUMB An 82 y/o male presents to the ED

More information

Disclosures. I have served as an advisory board member, consultant, speaker, and / or received research funding from: Sanofi-Aventis

Disclosures. I have served as an advisory board member, consultant, speaker, and / or received research funding from: Sanofi-Aventis TSOACs: Glee Lenoir, Pharm D. Pharmacy Clinical Coordinator The Medical Center Nursing Conference March 2015 Disclosures I have served as an advisory board member, consultant, speaker, and / or received

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

Xarelto (Rivaroxaban): Effective in a broad spectrum. Joep Hufman, MD Medical Scientific Liason

Xarelto (Rivaroxaban): Effective in a broad spectrum. Joep Hufman, MD Medical Scientific Liason Xarelto (Rivaroxaban): Effective in a broad spectrum Joep Hufman, MD Medical Scientific Liason Xarelto : Effective in a broad spectrum Introduction Therapeutic areas SPAF VTE Prevention VTE treatment Practical

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

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

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

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

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

More information

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

Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial

Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial Camillo Autore Università di Roma Sapienza II Facoltà di Medicina e Chirurgia

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