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

Size: px
Start display at page:

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

Transcription

1 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 Roper Hospital, Charleston, SC Describe the evidence-based role of rivaroxaban in anticoagulation therapy Evaluate the safety and efficacy profile of rivaroxaban Compare and contrast rivaroxaban to other oral anticoagulation therapy options Identify possible FDA-approved indications on the horizon Incorporate clinical pearls regarding the use of rivaroxaban into patient-specific care 1 XII XI IX XIIa X XIa IXa PT Xa Fibrinogen Xa inhibitor Rivaroxaban VIIa Thrombin Fibrin + Platelets VII 2 Rivaroxaban (Xarelto ) FDA Approved 7/1/2011 DVT prophylaxis in patients undergoing knee or hip replacement surgery 10 mg once daily (without regard for food at this dose) Begin 6 hours after surgery & hemostasis established Knee: continue for 12 days Hip: continue for 35 days F = %, 92-95% protein bound (1 O albumin) C max occurs in 2-4 hours Metabolism: 50% hepatically metabolized Excretion: ~ 1/3 urine as active drug ~ 1/3 urine as metabolite ~ 1/3 feces (metabolite + active drug) t ½ = 5 9 hours Special Populations Other Details Avoid use in hepatic impairment Moderate (Child-Pugh B) Experienced increased rivaroxaban exposure Severe (Child-Pugh C, excluded from study) Hepatic disease associated with coagulopathy Japanese subjects 50% higher AUC vs other ethnicities (including Chinese) Elderly 50% higher AUC t ½ = hours, age-related decline in renal function < 50 kg and > 120 kg: no influence on exposure OK to crush, but if tube used, must be in stomach to ensure absorption (stomach required for adequate absorption) Antidote not available Use of charcoal to reduce absorption Dialysis not useful highly protein bound Evidence emerging from healthy volunteers that PCC may be effective Circulation DOI: /Circulationaha

2 Rivaroxaban Efficacy Endpoints in Hip and Knee Arthroplasty 1. Death 2. Symptomatic DVT/PE in real-life, the ones that are detected and treated the ones that matter 3. VTE Legs assessed with Dopplers for the presence of VTE Usually asymptomatic Efficacy in Hip Arthroplasty Trial Regimens DVT/PE/ Symptomatic death VTE Record 1 Enoxaparin 40 mg 3.7% 0.5% N = 4541 Qday x 35 days RRR = 70% NS Rivaroxaban 10 mg 1.1% 0.3% Qday x 35 days DVT/PE/ Symptomatic Record 2 Enoxaparin 40 mg 9.3% 1.2% N = 2509 Qday x days RRR = 79% RRR = 80% Rivaroxaban 10 mg 2.0% 0.2% Qday x ~ 35d N Engl J Med 2008;358: Lancet 2008;372:31-9 Efficacy in Knee Arthroplasty Trial Regimens DVT/PE/ Symptomatic Record 3 Enoxaparin 40 mg 18.9% 2.0% N = 2531 Qday x days RRR = 49% RRR = 66% Rivaroxaban 10 mg 9.6% 0.7% Qday x days DVT/PE/ Symptomatic Record 4 Enoxaparin 30 mg 10.1% 1.2% N = 3148 BID x days RRR = 31% NS Rivaroxaban 10 mg 6.9% 0.7% Qday x days N Engl J Med 2008;358: Lancet 2009;373: Adverse Effects Enoxaparin Rivaroxaban Major Bleeding Record 1 0.3% 0.1% NS Record 3 0.5% 0.6% NS Record 4 0.3% 0.7% NS Any Bleeding Record 1 5.9% 6.0% NS Record 3 4.8% 4.9% NS Record 4 9.4% 10.5% NS N Engl J Med 2008;358: N Engl J Med 2008;358: Lancet 2009;373: Efficacy and Safety: Hip and Knee Arthroplasty Rivaroxaban equal to exoxaparin prevention of symptomatic VTE incidence of death bleeding Drug Interactions Rivaroxaban does not appear to affect any other drugs Several drugs affect rivaroxaban Substrate of CYP3A4/5 CYP2J2 P-glycoprotein (P-gp) transporter (ABCB1) ATP-binding cassette G2 transporter(abcg2) 2

3 Avoid Rivaroxaban Severe impairment of a major elimination pathway CrCl < 30 ml/min Strong 3A4 and p-glycoprotein inhibitor AUC increase 150% Ketoconazole, itraconazole, lopinovir, ritonavir, indinivir, conivaptan Rivaroxaban OK Moderate P-glycoprotein and 3A4 inhibitors Clarithromycin, erythromycin Only minor AUC increases observed Caution with Rivaroxaban: benefits >> risks 2 small strikes at elimination pathways Renal impairment (ClCr ml/min) AND P-gp and weak/moderate CYP 3A4 inhibitors Erythromycin, azithromycin, diltiazem, verapamil, quinidine, ranolazine, dronedarone, amiodarone, felodipine Avoid or Increase dose P-gp inducer + strong CYP3A4 inducer 50% decrease in AUC Increase dose to 20 mg (take w food) Rifampicin, carbamazepine, phenytoin, rifampin, st. John s wort Anticoagulants for VTE prevention after arthroplasty LMWH Warfarin Dabigatran Rivaroxaban Cost $440 $ 15 $ 40 $ 60 Route SQ PO PO PO Onset hours days hours hours Drug zero extensive 1(rare) many Interactions Adverse none none GI upset none Effects SCIP-VTE yes yes w/ hoop w/ hoop Measure jumping jumping compliant?* *as of August 10, 2011 Future Indications? Atrial fibrillation Dabigatran: FDA approved Rivaroxaban FDA committee recommends Yes September 2011 FDA to review in November 2011 DVT/PE treatment Dabigatran:RE-COVER trial Not under review at FDA for this indication Rivaroxaban: EINSTEIN trial Not under review at FDA for this indication EMA committee recommends Yes September 2011 EMA to review by December

4 Future Indications? Acute Coronary Syndromes Data reportedly positive for rivaroxaban via press release ATLAS-ACS 2, TIMI 51 decreased events, but increased bleeding May be presented in November 2011 AHA meeting Data for apixaban in ACS was overall negative Decreased cardiovascular events Increased bleeding Rivaroxaban in Atrial Fibrillation ROCKET AF trial N = 14,264 (double-blind, randomized, 45 countries) Warfarin (INR 2 3) Rivaroxaban 20 mg QDay or 15mg QDay ClCr ml/min None-inferiority trial Primary endpoint: Stroke or systemic embolism Moderate/high risk of stroke CHADS 2 score 2 (0-6 point scale) CHF, HTN, age > 75, DM, stroke/tia Rivaroxaban in Atrial Fibrillation Results Duration of treatment: median 1.6 years Drop-outs: 23.7% and 22.2% Warfarin Rivaroxaban Age Female 40% 40% CHADS % 13% 3 44% 43% 4 28% 29% 5 12% 13% 6 2% 2% Results Stroke or Systemic Embolism (PPY) Overall ITT Warfarin Rivaroxaban stat. interpr. Stroke/embolism 2.4% 2.1% non-inferior During Treatment 2.2% 1.7% superior Following 43% 4.3% 47% 4.7% NS discontinuation (~ 23% of population) Clinically relevant 14.5% 14.9% NS Bleeding Major Bleeding 3.4% 3.6% NS How did the 15mg dose perform? 1. Renal Dysfunction 15 mg dose (ClCr ml/min) 21% of the population Warfarin 2.77% vs Rivaroxaban 2.38% P = NS FDA Draft Briefing Document for the Cardiovascular and Renal Drugs Advisory Committee (CRDAC) Meeting Date: 8 September 2011,NDA: FDA Concerns 1. New therapy must be as effective as an approved therapy when the approvedtherapy drug is used skillfully Warfarin was not used as skillfully in ROCKET as in RE-LY (dabigatran) and other recent trials, thereby making it difficult to assess the true efficacy of rivaroxaban. Warfarin Time-in-Therapeutic Range (TTR) RELY (dabigatran) 67% ARISTOTLE (apixaban) 66% Many anticoagulation centers ~ 70% ROCKET AF (rivaroxaban) 58% 4

5 FDA Concerns 2. Because of a high number of events observed in patients when they discontinued use of rivaroxaban, there is no firm guidance for how to transition patients to warfarin or other drugs when rivaroxaban is discontinued. Upon study end, rivaroxaban was discontinued, and warfarin initiatiaed (without bridging ) In first 30 days Rivaroxaban warfarin = 22 strokes/embolic events Warfarin warfarin = 6 strokes/embolic events FDA Concerns 3. The optimal dose of rivaroxaban is still unclear. Many on the committee thought rivaroxaban might perform better as a twice-a-day drug. Big Issues for Hospitals Reversibility What to do if patient comes in bleeding or needs emergency surgery SCIP-VTE Core Measure Currently, only LMWH and warfarin are automatically acceptable Documentation currently required if this agent used for VTE prophylaxis in place of acceptable agents TJC National Patient Safety Goal Reduce the likelihood of patient harm associated with the use of anticoagulant therapy TJC: Elements of Performance Evidence of a written policy that addresses baseline and ongoing tests required for anticoagulation. Provide education regarding anticoagulation therapy to prescribers, staff, patients, and families. Evaluate anticoagulation safety practices. Issues for Everybody Take with food? Only sometimes?? Linear and high bioavailability up to 15 mg The ROCKET AF study (20 mg/day) gave each dose with food to ensure adequate absorption Low albumin (or highly hl protein bound drug) Japanese ethnicity Elderly (moderate renal dysfunction) and increased exposure Especially if used for long-term Drug Interactions Summary Rivaroxaban 10 mg Qday is as effective as standard therapy for the prevention of VTE following arthroplasty (hip or knee) No significant adverse effects outside of bleeding Drug interactions must be managed ClCr > 30 ml/min required FDA to address atrial fibrillation indication in Fall 2011 Apixiban may be submitted to FDA year end 2011 Atrial fibrillation (ARISTOTLE, N Engl J Med 2011;365:981-92) 5

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

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

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

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

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

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

More information

Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical

Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Center A.Fib affects 2.2 million Americans. The lifetime

More information

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

Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation

Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 29,

More information

New Oral Anticoagulants

New Oral Anticoagulants 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 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

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

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

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

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

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 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

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

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

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

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. 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

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

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

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

Comparison between New Oral Anticoagulants and Warfarin

Comparison between New Oral Anticoagulants and Warfarin Comparison between New Oral Anticoagulants and Warfarin Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. In recent years, several

More information

Anticoagulation: 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Women at Risk: Anticoagulation Issues in Atrial Fibrillation

Women at Risk: Anticoagulation Issues in Atrial Fibrillation Page 1 WOMEN AT RISK Anticoagulation Issues In Atrial Fibrillation WOMEN AT RISK Anticoagulation Issues In Atrial Fibrillation J E A N N A P P I, P H A R M. D., F C C P, B C P S Accreditation: Pharmacists:

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

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

New Anticoagulants: Are we Ready to Replace Warfarin? Carole Goodine, RPh Horizon Health Network Stroke Conference 2011

New Anticoagulants: Are we Ready to Replace Warfarin? Carole Goodine, RPh Horizon Health Network Stroke Conference 2011 New Anticoagulants: Are we Ready to Replace Warfarin? Carole Goodine, RPh Horizon Health Network Stroke Conference 2011 Warfarin Decreases stroke risk by 60-70% Superior to ASA and ASA plus clopidogrel

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

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

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

Comparative Anticoagulation

Comparative Anticoagulation Comparative Anticoagulation Laurajo Ryan, PharmD, MSc, BCPS, CDE Clinical Associate Professor The University of Texas at Austin College of Pharmacy The University of Texas Health Science Center Pharmacotherapy

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

2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2.

2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2. Anticoagulation dosing at UCDMC (SC=subcutaneously; CI=continuous infusion) Indication Agent Dose Comments Prophylaxis Any or No bleeding risk factors see adult heparin (VTE prophylaxis) IV infusion order

More information

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

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

More information

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

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

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 ORAL ANTICOAGULANT THERAPY An audit from 6 Acute Hospitals

NOVEL ORAL ANTICOAGULANT THERAPY An audit from 6 Acute Hospitals NOVEL ORAL ANTICOAGULANT THERAPY An audit from 6 Acute Hospitals Co-Investigators: Bernard Carr, Dr Aisling O Leary, Dr Michael Barry Pharmacy Interns: Karyn Clerkin, Aoife Boyle, Kieran Walsh, Mairead

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

Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2015

Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2015 Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2015 General Principles: There is compelling data in the medical literature to support

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

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

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

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

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

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

New oral anticoagulants and antiplatelets: Where do they fit? Meredith Hollinger, PharmD BCPS

New oral anticoagulants and antiplatelets: Where do they fit? Meredith Hollinger, PharmD BCPS New oral anticoagulants and antiplatelets: Where do they fit? Meredith Hollinger, PharmD BCPS Clinical Pharmacy Specialist, Cardiology September 2012 Objectives Describe the mechanisms of action for novel

More information

Analytical Specifications RIVAROXABAN

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

More information

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

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

Atrial Fibrillation Current State of Management with Importance to Newer Anticoagulants and Devices

Atrial Fibrillation Current State of Management with Importance to Newer Anticoagulants and Devices Atrial Fibrillation Current State of Management with Importance to Newer Anticoagulants and Devices Garland Green, MD Interventional Cardiologist Cardiovascular Institute of the South Atrial fibrillation

More information

New Anticoagulants- Dabigatran/Rivaroxaban

New Anticoagulants- Dabigatran/Rivaroxaban New Anticoagulants- Dabigatran/Rivaroxaban JOHN NOVIASKY, PHARMD, BCPS, FNYSCHP CGH AT UPSTATE UNIVERSITY HOSPITAL SYRACUSE NY Objectives Describe the risks and benefits of dabigatran therapy Describe

More information

Timeline: FDA approval of NOACs. FDA-approved oral anticoagulants. FDA-approved oral anticoagulants. Stroke risk reductions: afib RCTs 4/8/2016

Timeline: FDA approval of NOACs. FDA-approved oral anticoagulants. FDA-approved oral anticoagulants. Stroke risk reductions: afib RCTs 4/8/2016 Christina York, PharmD, BCPS Pharmacology Conference April 2016 Objectives Compare current FDA-approved oral anticoagulants Understand practical issues that arise with novel oral anticoagulants Consider

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

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

New Oral Anticoagulant (Rivaroxaban [Xarelto])

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

More information

Can we RE-LY on new oral anticoagulants to prevent cardioembolic stroke?

Can we RE-LY on new oral anticoagulants to prevent cardioembolic stroke? CSHP-B Branch Education, B Pharmacy Conference, May 29, 2010 Can we RE-LY on new oral anticoagulants to prevent cardioembolic stroke? Douglas Doucette, BSc(Pharm), PharmD, FCSHP Regional Pharmacy Clinical

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

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

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

Atrial Fibrillation Current State of Management with Importance to Newer Anticoagulants and Devices

Atrial Fibrillation Current State of Management with Importance to Newer Anticoagulants and Devices Atrial Fibrillation Current State of Management with Importance to Newer Anticoagulants and Devices Garland Green, MD Interventional Cardiologist Cardiovascular Institute of the South Disclosures: Speaker

More information

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

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

More information

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

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

Making Sense of the Newer Anticoagulants

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

More information

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

Anticoagulation Therapy Update

Anticoagulation Therapy Update Anticoagulation Therapy Update JUDY R. WALLING, FNP-BC ARRHYTHMIA MANAGEMENT MUSC CARDIOLOGY Outline Who do we anticoagulate? Review classes of Anticoagulants Review examples of Anticoagulants Review CHADS2

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

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

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

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

New Oral Anticoagulants: Thinning out the competition

New Oral Anticoagulants: Thinning out the competition New Oral Anticoagulants: Thinning out the competition Ashlee D. Gerfen, Pharm.D. University of Arizona Medical Center PGY2 Critical Care Pharmacy Resident DISCLOSURE I have no financial interest, arrangement,

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