Should Bioprostheses be Anticoagulated?

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Should Bioprostheses be Anticoagulated?"

Transcription

1 Should Bioprostheses be Anticoagulated? Hartzell V. Schaff, MD AATS 2013 Heart Valve Summit Chicago, IL September 26-28, MFMER slide-1

2 Guidelines for AC of Bioprostheses 1. ASA - Class I indication for AVR, not MVR 2. Warfarin for 3 mo. Class I indication following MVR 3. Dual antiplatelet agents Class IIa indication following AVR 4. None of the above 5. All of the above 2012 MFMER slide-2

3 ACC/AHA Guidelines 2006 Management of Patients with Valvular Heart Disease 2012 MFMER slide-3

4 ACC/AHA Guidelines 2006 Risk Factors for AC in Patients with Bioprostheses Atrial fibrillation LV dysfunction (EF<30%) Previous thromboembolism Hypercoagulable condition Left atrial size? Echocardiographic characteristics? Management of VKA? 2012 MFMER slide-4

5 Mitral Valve Replacement STS Valve Type % 2012 MFMER slide-5

6 22 y/o Female AVCD 3 yr s/p MVR 2012 MFMER slide-6

7 77 y/o Male Ischemic MR 2.5 yr s/p MVR 2012 MFMER slide-7

8 8 patients, aged 77 yr, time to reoperation 398 days (range, days) 2012 MFMER slide-8

9 56 Yr old ER M.D., EF 21% 2 yr s/p AVR 2012 MFMER slide-9

10 What do we do? General Expectation That Most AVR Patients Without Comorbidities Need to be Treated with Warfarin 2012 MFMER slide-10

11 What do we do? Does Warfarin Use Prolong Hospital Stay Following AVR in Patients Without Comorbidities? 2012 MFMER slide-11

12 Average Days Added by Warfarin Use in AVR Patients Without Comorbidities 2012 MFMER slide-12

13 What do we do? Belief that Anti-platelet Therapy is an Acceptable Alternative to Warfarin in AVR Patients Without Comorbidities 2012 MFMER slide-13

14 Belief That Warfarin Therapy for Three Months is No Longer Standard of Care after AVR in Patients Without Comorbidities 2012 MFMER slide-14

15 Conclusions: Although these data do not address the role of antiplatelet agents, early anticoagulation with warfarin after bioprosthetic aortic valve replacement did not appear to protect against neurologic events MFMER slide-15

16 Conclusions Early after bavr, the effects of these 2 antithrombotic regimens on cerebral microembolization and platelet function are equivalent. These data bring new mechanistic support to the premise that aspirin only may safely be used early after bavr in patients who have no other indication for oral anticoagulation MFMER slide-16

17 Conclusions Early anticoagulation after isolated bioprosthetic aortic valve replacement in patients in normal sinus rhythm does not seem to reduce the risk of thromboembolism except in highrisk groups. Current recommendations should be revisited, because the only patients who may benefit from anticoagulation are female, those who are highly symptomatic, and those with a small aortic prosthesis MFMER slide-17

18 2012 MFMER slide-18

19 2012 MFMER slide-19

20 Anticoagulation for Bioprostheses STS Brennan et al, JACC MFMER slide-20

21 2012 MFMER slide-21

22 Conclusions Death and embolic events were relatively rare in the first 3 months after bioprosthetic aortic valve replacement. Compared with aspirin-only, aspirin plus warfarin was associated with a reduced risk of death and embolic events, but at the cost of an increased bleeding risk MFMER slide-22

23 JAMA. 2012;308(20): MFMER slide-23

24 2012 MFMER slide-24

25 2012 MFMER slide-25

26 2012 MFMER slide-26

27 within 90 to 180 days after surgery, we found that for every 23 (95% CI, 14-54) patients not being treated with warfarin, 1 patient died from cardiovascular cause 2012 MFMER slide-27

28 within 90 to 180 days after surgery, for every 74 (95% CI, 27-95) patients being treated with warfarin, 1 patient experienced bleeding complications requiring hospital admission 2012 MFMER slide-28

29 Conclusion Discontinuation of warfarin treatment within 6 months after bioprosthetic AVR surgery was associated with increased cardiovascular death. JAMA. 2012;308(20): MFMER slide-29

30 Anticoagulation of Bioprostheses Key Points ASA for all pt Life-long warfarin for patients with risk factors Warfarin for 3 months following MVR Need data New data suggests benefit of warfarin for 6 months following AVR Trials of anticoagulation and dual antiplatelet drugs 2012 MFMER slide-30

31 Questions & Discussion 2012 MFMER slide-31

32 What do we do? Belief That Anti-platelet Therapy Alone Addresses Patient Safety While Reducing LOS and Cost 2012 MFMER slide-32

STROKE PREVENTION IN ATRIAL FIBRILLATION

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

More information

The Anti coagulated Patient: The Cardiologist s View. February 28, 2015

The Anti coagulated Patient: The Cardiologist s View. February 28, 2015 The Anti coagulated Patient: The Cardiologist s View February 28, 2015 Conflicts Dr. McMurtry has no conflicts to disclose. CanMeds Medical Expert (as Medical Experts, physicians integrate all of the CanMEDS

More information

To Bridge or Not to Bridge. Periop Anticoagulation Management. Don Weinshenker, MD Ambulatory Care Denver VAMC

To Bridge or Not to Bridge. Periop Anticoagulation Management. Don Weinshenker, MD Ambulatory Care Denver VAMC To Bridge or Not to Bridge Periop Anticoagulation Management Don Weinshenker, MD Ambulatory Care Denver VAMC Financial Disclosure Information Nothing to report Periop AC Management Chronically anti-coagulated

More information

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

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

More information

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

9/5/14. Objectives. Atrial Fibrillation (AF)

9/5/14. Objectives. Atrial Fibrillation (AF) Novel Anticoagulation for Prevention of Stroke in Patients with Atrial Fibrillation Objectives 1. Review current evidence on use of warfarin in individuals with atrial fibrillation 2. Compare the three

More information

UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient

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

More information

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

Managing Mitral Regurgitation: Repair, Replace, or Clip? Michael Howe, MD Traverse Heart & Vascular

Managing Mitral Regurgitation: Repair, Replace, or Clip? Michael Howe, MD Traverse Heart & Vascular Managing Mitral Regurgitation: Repair, Replace, or Clip? Michael Howe, MD Traverse Heart & Vascular Mitral Regurgitation Anatomy Mechanisms of MR Presentation Evaluation Management Repair Replace Clip

More information

Anticoagulants in Atrial Fibrillation

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

More information

Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE

Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with

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

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

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

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

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

None. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015

None. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015 Financial Disclosure Information Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Dual Antiplatelet

More information

WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION. Van Crisco, MD, FACC, FSCAI First Coast

WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION. Van Crisco, MD, FACC, FSCAI First Coast WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION Van Crisco, MD, FACC, FSCAI First Coast Conflicts of Interest I have been a paid consultant and speaker for AstraZeneca, makers of

More information

Objectives of Session

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

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY

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

More information

GUIDELINES IN ANTIPLATELET AND ANTICOAGULATION RX IN CARDIAC SURGERY

GUIDELINES IN ANTIPLATELET AND ANTICOAGULATION RX IN CARDIAC SURGERY BLOOD CONSERVATION STRATEGIES IN CARDIAC SURGERY: MORE IS BETTER GUIDELINES IN ANTIPLATELET AND ANTICOAGULATION RX IN CARDIAC SURGERY DIMITRIOS V. AVGERINOS MD, PhD, FACS, FACC Department of Cardiac Surgery,

More information

Atrial Fibrillation Peter Santucci, MD Revised May, 2008

Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial fibrillation (AF) is an irregular, disorganized rhythm characterized by a lack of organized mechanical atrial activity. The atrial rate is

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

New Anticoagulants and GI bleeding

New Anticoagulants and GI bleeding New Anticoagulants and GI bleeding DR DANNY MYERS MD FRCP(C) CLINICAL ASSISTANT PROFESSOR OF MEDICINE, UBC Conflicts of Interest None I am unbiased in the use of NOAC s vs Warfarin based on risk benefit

More information

Atrial Fibrillation The Basics

Atrial Fibrillation The Basics Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation

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

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

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

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

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

More information

New in Atrial Fibrillation

New in Atrial Fibrillation New in Atrial Fibrillation September 2011 Stroke prevention more options Rhythm Control -drugs - alternatives to drugs; ablation Rate Control - pace + ablate A-FIB Dell Stroke Risk AFib Two Principles

More information

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor

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

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

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

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

Surgical Mitral Valve Repair The Gold Standard. A. Marc Gillinov, M.D.

Surgical Mitral Valve Repair The Gold Standard. A. Marc Gillinov, M.D. Surgical Mitral Valve Repair The Gold Standard A. Marc Gillinov, M.D. Disclosures Speaker/consultant Edwards Lifesciences Onyx Lifesciences Research support St. Jude Medical Medtronic A Common Case A Common

More information

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

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

More information

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

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

More information

RR 0.88 (95% CI: 0.77 1.00) P=0.051 (superiority) 3.75

RR 0.88 (95% CI: 0.77 1.00) P=0.051 (superiority) 3.75 ALL-CAUSE MORTALITY RR 0.88 (95% CI: 0.77 1.00) P=0.051 (superiority) Rate per year (%) 5.0 4.0 3.0 2.0 1.0 0 3.64 D150 mg BID 3.75 D110 mg BID RR 0.91 (95% CI: 0.80 1.03) P=0.13 (superiority) 4.13 Warfarin

More information

New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis

New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET Departments of Gastroenterology and Hepatology,

More information

Clinical Practice Guideline for Anticoagulation Management

Clinical Practice Guideline for Anticoagulation Management Clinical Practice Guideline for Anticoagulation Management This guideline is to inform practitioners of the Standard of Care for providing safe and effective anticoagulation management for ambulatory patients.

More information

A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation

A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE What is atrial fibrillation? Atrial fibrillation

More information

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

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

More information

Cardiologie Interventionnelle non Coronaire en Jean-Michel Juliard Hôpital Bichat, Paris

Cardiologie Interventionnelle non Coronaire en Jean-Michel Juliard Hôpital Bichat, Paris Cardiologie Interventionnelle non Coronaire en 2010 Jean-Michel Juliard Hôpital Bichat, Paris Cardiologie Interventionnelle non Coronaire en 2010 Rétrécissement aortique : valves aortiques par voie transfémorale

More information

Atherosclerosis of the aorta. Artur Evangelista

Atherosclerosis of the aorta. Artur Evangelista Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis

More information

Anticoagulation in Atrial Fibrillation

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

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

Non-Valvular Atrial Fibrillation & Anticoagulation Therapy: An Actuarial Study of the Medicare Population

Non-Valvular Atrial Fibrillation & Anticoagulation Therapy: An Actuarial Study of the Medicare Population Non-Valvular Atrial Fibrillation & Anticoagulation Therapy: An Actuarial Study of the Medicare Population Prepared by: Milliman, Inc., NY Kathryn Fitch, RN, MEd Principal and Healthcare Management Consultant

More information

Atrial Fibrillation: A Different Perspective. Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital

Atrial Fibrillation: A Different Perspective. Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital Atrial Fibrillation: A Different Perspective Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital Faculty/Presenter Disclosure Faculty: Dr. Michael Heffernan Relationships with commercial

More information

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize

More information

National Medicines Information Centre

National Medicines Information Centre National Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie THE CONTEMPORARY MANAGEMENT OF ATRIAL FIBRILLATION VOLUME 12 NUMBER 3 2006

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

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

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

Guidelines for the Use of Antithrombotic Agents in Cardiac Patients. Stuart J Smith MD Chief of Cardiovascular Services SMGH / GRH

Guidelines for the Use of Antithrombotic Agents in Cardiac Patients. Stuart J Smith MD Chief of Cardiovascular Services SMGH / GRH Guidelines for the Use of Antithrombotic Agents in Cardiac Patients Stuart J Smith MD Chief of Cardiovascular Services SMGH / GRH Disclosure of Potential for Conflict of Interest Speaker: Dr Stuart J Smith,

More information

Presenter: Marco Valgimigli, MD PhD, FESC Erasmus MC, Thoraxcenter Rotterdam The Netherlands

Presenter: Marco Valgimigli, MD PhD, FESC Erasmus MC, Thoraxcenter Rotterdam The Netherlands Comparing zotarolimus-eluting and bare-metal stent efficacy in selected high bleeding risk patients treated with a short dual antiplatelet therapy duration. A pre-specified analysis from the The Zotarolimuseluting

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

WARFARIN DOSING GUIDELINE

WARFARIN DOSING GUIDELINE DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care

More information

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

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

More information

Prevention of stroke in patients with atrial fibrillation

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

More information

Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute

Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute Dual Antiplatelet Therapy Stephen Monroe, MD FACC Chattanooga Heart Institute Scope of Talk Identify the antiplatelet drugs and their mechanisms of action Review dual antiplatelet therapy in: The medical

More information

CARDIAC RISKS OF NON CARDIAC SURGERY

CARDIAC RISKS OF NON CARDIAC SURGERY CARDIAC RISKS OF NON CARDIAC SURGERY N E W S T U D I E S & N E W G U I D E L I N E S W. B. C A L H O U N, M D, F A C C 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management

More information

Hot Topics: Current PFO Recommendations and Loop Monitoring/Cryptogenic Stroke.

Hot Topics: Current PFO Recommendations and Loop Monitoring/Cryptogenic Stroke. Hot Topics: Current PFO Recommendations and Loop Monitoring/Cryptogenic Stroke. Favoriteplus.com www.heartrhythmcharity.org.uk www.forbes.com Victor J. Mazza, MD Assistant Professor of Medicine Cardiology,

More information

Optimal Duration of Dual Antiplatelet Therapy

Optimal Duration of Dual Antiplatelet Therapy Optimal Duration of Dual Antiplatelet Therapy Luis A Guzman, MD, FACC, FSCAI Associate Professor of Medicine Director, Cardiac and Vascular Cath Lab University of Florida College of Medicine - Jacksonville

More information

Rx Updates New Guidelines, New Medications What You Need to Know

Rx Updates New Guidelines, New Medications What You Need to Know Rx Updates New Guidelines, New Medications What You Need to Know Maria Pruchnicki, PharmD, BCPS, BCACP, CLS Associate Professor of Clinical Pharmacy OSU College of Pharmacy Background scope and impact

More information

DISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015

DISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015 Death (%) Mortality (%) 9/16/2015 DISCLOSURE Atrial Fibrillation Management An Evidence-based Approach Jonathon Adams, MD, FHRS Relevant Financial Relationship(s) None Off Label Usage None OBJECTIVES What

More information

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

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

More information

Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation (ISAR-TRIPLE Trial)

Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation (ISAR-TRIPLE Trial) Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation (ISAR-TRIPLE Trial) Katrin A. Fiedler, Michael Maeng, Julinda Mehilli, Stefanie Schulz, Robert

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

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,

More information

Perioperative Anticoagulation Management

Perioperative Anticoagulation Management Perioperative Anticoagulation Management Wendy Lim, MD, MSc, FRCPC Department of Medicine, Division of Hematology- Thromboembolism, McMaster University Surgery Half-Day April 21, 2010 Objectives 1. To

More information

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,

More information

Objectives. Patient Background. Transitioning a Patient To & From a New Oral Anticoagulant

Objectives. Patient Background. Transitioning a Patient To & From a New Oral Anticoagulant Objectives Transitioning a Patient To & From a New Oral Anticoagulant How to switch from warfarin to rivaroxaban Discuss the Medicare donut hole How to switch from rivaroxaban to warfarin Home INR monitoring

More information

Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation

Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation On the following pages are a number of questions asking about the conditions under which you would prescribe anticoagulation

More information

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

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

More information

Updates to the Alberta Human Services Drug Benefit Supplement

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

More information

Management of Atrial Fibrillation in Heart Failure

Management of Atrial Fibrillation in Heart Failure Disadvantages of AV Junction Ablation Persistent AFib- no AV synchrony Ongoing risk of thromboembolism Life-long dependency on pacemaker Comparison of LA Ablation vs. AVN Ablation LA Ablation AVN Ablation

More information

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

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

More information

Atrial Fibrillation: Drugs, Ablation, or Benign Neglect. Robert Kennedy, MD October 10, 2015

Atrial Fibrillation: Drugs, Ablation, or Benign Neglect. Robert Kennedy, MD October 10, 2015 Atrial Fibrillation: Drugs, Ablation, or Benign Neglect Robert Kennedy, MD October 10, 2015 Definitions 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary.

More information

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

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

More information

Bios 6648: Design & conduct of clinical research

Bios 6648: Design & conduct of clinical research Bios 6648: Design & conduct of clinical research Section 1 - Specifying the study setting and objectives 1. Specifying the study setting and objectives 1.0 Background Where will we end up?: (a) The treatment

More information

Anticoagulation before and after cardioversion; which and for how long

Anticoagulation before and after cardioversion; which and for how long Anticoagulation before and after cardioversion; which and for how long Sameh Samir, MD Cardiovascular medicine dept. Tanta faculty of medicine Atrial fibrillation goals of management Identify and treat

More information

Adjusted dose Warfarin vs. placebo

Adjusted dose Warfarin vs. placebo Adjusted dose Warfarin vs. placebo AFASAK I- 1989 18 years ECG- verified chronic AF Previous anticoagulation therapy for more than 6 months, cerebrovascular events within the past month, contraindications

More information

Atrial Fibrillation An update on diagnosis and management

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

More information

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

Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps

Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps Cheryl Ea, Pharm D. Anticoagulation Services Scripps Clinic and Scripps Green Hospital La Jolla, California Pharmacist Management

More information

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

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

More information

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

or can your blood ever really be too thin? Jason Haag

or can your blood ever really be too thin? Jason Haag Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8 th Edition) i Anticoagulation in Coronary Artery disease: or can your blood

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

A focus on atrial fibrillation

A focus on atrial fibrillation A focus on atrial fibrillation Is being female really a risk factor for stroke? Dr Justin Mariani MBBS BMedSci PhD FRACP FCSANZ Consultant Cardiologist and Interventional Heart Failure Specialist Alfred

More information

Anticoagulation For Atrial Fibrillation

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

More information

Ashley Chin. Cardiac Electrophysiologist Groote Schuur Hospital UCT Private Academic Hospital. SA Heart Lecture Series Atrial Fibrillation

Ashley Chin. Cardiac Electrophysiologist Groote Schuur Hospital UCT Private Academic Hospital. SA Heart Lecture Series Atrial Fibrillation Ashley Chin Cardiac Electrophysiologist Groote Schuur Hospital UCT Private Academic Hospital Pathogenesis of AF Focal triggers and a susceptible substrate -> AF Pulmonary veins are the crucial source of

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

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

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

More information

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

CHADS score of 5 or 6 Recent (within 3mo) stroke or TIA Rheumatic valvular heart disease CHADs score of 3 or 4

CHADS score of 5 or 6 Recent (within 3mo) stroke or TIA Rheumatic valvular heart disease CHADs score of 3 or 4 LAMC Department of Pharmacy Services: ANTICOAGULATION: Surgical Intervention Table 1: Classification of Surgical interventions according to bleeding risk t required to discontinue anticoagulation Dental

More information

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

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications

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

Bayer Extends Clinical Investigation of Rivaroxaban into Important Areas of Unmet Medical Need in Arterial Thromboembolism

Bayer Extends Clinical Investigation of Rivaroxaban into Important Areas of Unmet Medical Need in Arterial Thromboembolism Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Bayer Extends Clinical Investigation of Rivaroxaban into Important Areas of

More information