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

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

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

Transcription

1 Optimizing Anticoagulation Therapy for Older Adults with Atrial Fibrillation: The New Oral Agents" None Disclosures Brad Hein, PharmD Associate Professor of Pharmacy The University of Cincinnati Winkle College of Pharmacy Learning Objectives Describe recent changes to clinical practice guidelines that reflect new best practices in the use of antithrombotic therapy for patients with AF. Identify the under-recognized risk of cardioembolic stroke in untreated and undertreated NVAF patients and the diseaseassociated morbidity, mortality and cost burdens Learning Objectives Compare the current guidance and new developments for reversing the anticoagulant effect of VKAs, direct thrombin inhibitors, or factor Xa inhibitors. Effectively assess the risk/benefit ratio of cardioembolic stroke prophylaxis for the NVAF Explain key differences in the pharmacologic profiles of the new oral anticoagulants that may impact selection of a specific agent for an individual older adult patient. Atrial Fibrillation Paroxysmal Persistent Permanent Introduction Self-Terminating Lasts > 7 Days Cardioversion Failed or Not Attempted Normal Sinus Rhythm Atrial Fibrillation Paroxysmal AF is as likely to cause stroke as persistent or permanent AF 1

2 Factors contributing to increased risk for stroke in NVAF1 FLORIDA ASCP 14 FLORIDA ASCP 14 CHADS 2 CHA 2 DS 2 VASc C= Congestive Heart Failure H= Hypertension A= Age > 75 D= Diabetes S= Stroke/TIA (2pts) CHADS 2 Score Risk Level 0 Low 1% 1 Lowmoderate Stroke Rate/Yr 1.5% 2 Moderate 2.5% 3 High 5% 4-6 Very high 7%-18% C= Congestive Heart Failure H= Hypertension A= Age 75 (2 pts) D= Diabetes S= Stroke/TIA (2 pts) V = Vascular disease A= S= Female CHA 2 DS 2 VASc Score Risk Level Stroke Rate/Yr 0 Low 0% 1 Low 1.3% 2 Moderate 2.2% 3 Moderate 3.2% 4 High 4% 5 High 6.7% 6-8 High % 9 Very high 15.2% Prevalence, percent Relationship BetweenAtrial Fibrillation and Age Epidemiology and Health Burden 75% of strokes occur in individuals > 65 years of age 9% of those aged 80 have AFIB 24% of strokes between the ages of are secondary to AFIB Total = $34 billion/year o Economic burden of ischemic stroke and hemorrhage are similar, about $26,000/year Age, years Go AS, et al. JAMA. 2001; 285:

3 Benefits of Anticoagulation in Atrial Fibrillation in the Elderly Benefits oanticoagulants are more effective at stroke prevention in patients 65 and over versus younger patients At least a 65% reduction in stroke risk Benefit increases with age Warfarin reduces risk of stroke by >50% compared to aspirin Risksof Anticoagulation in Atrial Fibrillation in the Elderly Risks o Elderly patients have a higher risk of bleeding This is true in warfarin as well as in novel anticoagulant studies Age 80 and greater, 13% risk of major bleeding on warfarin (5% risk for those less than 80 years) Mortality doubles after a fall for patients on oral anticoagulants versus those who are not overy small absolute risk (1 or 2 additional SDH per 10,000 falls) opatients with AFIB are 2.5 times more likely to fall vs those without Eligible AFIB Patients Receiving Anticoagulation Prophylaxis Suboptimal o Falls, dementia, short life expectancy, history of bleeding Warfarin use in patients with AFIB and no contraindications (ATRIA study) o years, 60% of eligible patients o >84 years, 35% of eligible patients In a study of > 10,000 US elderly long term care residents with a history of stroke and AFIB o 54% of patients received nothing o 27% warfarin o 14% aspirin Lowest Effective Intensity for Warfarin Therapy for Stroke Prevention in Atrial Fibrillation INR below 2.0 results in a higher risk of stroke Singer DE, et al. Circ Cardiovasc Qual Outcomes. 2009;2(4): Quilliam BJ, et al. Stroke. 2001; 32: Hylek EM, et al. NEHM 1996;335: Known Issues with Warfarin 1) Delayed onset/offset 2) Unpredictable dose response o Elderly intrinsically more sensitive to warfarin 3) Narrow therapeutic index 4) Drug-drug, drug-food interactions o Polypharmacy 5) Problematic monitoring 6) High bleeding rate 7) Slow reversibility Therapy Novel Oral Anticoagulants (NOAC) (Pradaxa) Rivaroxaban (Xarelto) Apixaban (Eliquis) 3

4 Warfarin Rivaroxaban Apixaban Characteristics of Novel Agents Rivaroxaban Apixaban Target Thrombin Xa Xa Prodrug Yes No No Time to peak (h) Half-life(h) CYP metabolism None 32% 15% Renal elimination 80% 35% 25% Antidote None None None Daily dosing 150mg BID 20mg QD 5mg BID Lip GYH, et al. JACC 2012;60: Clinical Trial Comparison Pivotal Trials: Baseline Characteristics RE-LY () ARISTOTLE (Apixaban) ROCKET-AF (Rivaroxaban) # Enrolled 18,113 18,201 14,264 Age (yrs) 72 ±9 70 [63-76] 73 [65-78] Female 36% 35% 40% CHADS 2 score 3 32% 30% 87% VKA naive 50% 43% 38% Paroxysmal AF 33% 15% 18% Prior stroke/tia 20% 19% 55% Diabetes 23% 25% 40% Prior CHF 32% 35% 62% Hypertension 79% 87% 91% Connolly SJ et al. N Engl J Med 2009; 361: Patel MR et al. N Engl J Med 2011; 365: Granger CB et al. N Engl J Med 2011; 365: Pivotal Trials: Key Results Pooled Efficacy Drug Dose (mg) RE-LY ROCKET-AF ARISTOTLE 110 bid 150 BID Stroke + SEE non-infer Superior Rivaroxaban 20 mg qd ITT cohort: non-infer. On Rx cohort: Superior Apixaban 5 mg bid Superior ICH Superior Superior Superior Superior Bleeding Lower similar similar Lower Mortality similar P = similar Superior: P = Ischemic stroke similar Lower similar similar Mean TTR 64% 55% 62% Stopped drug 21% 23% 23% WD consent 2.3% 8.7% 1.1% Stroke & SEE Ischemic & Unsp. Stroke Hemorrhagic Stroke 22% 13% 55% Connolly SJ et al. N Engl J Med 2009; 361: Patel MR et al. N Engl J Med 2011; 365: Granger CB et al. N Engl J Med 2011; 365: Favors NOACs Miller CS, et al. Am J Cardiol 2012;110(3): Favors Warfarin 24 4

5 Bleeding Major ICH GI Pooled Safety 51% 25%, NS Clinical Findings in Elderly Subpopulations o No change in efficacy for those > 75 years o Incidence of major bleeding similar to warfarin in those > 75 years Less intracranial bleeding but more extracranial bleeding Rivaroxaban o 20% more effective than warfarin for those > 75 years o Similar safety Apixaban o Trend toward improved efficacy and safety for those > 75 years Favors NOACs Miller CS, et al. Am J Cardiol 2012;110(3): Favors Warfarin Consensus Guidelines Recommendations CHEST 2012 Stroke Prevention in Non-Valvular Atrial Fibrillation CHADS 2 Score Risk Level Stroke Rate/Yr Treatment 0 Low 1% No therapy preferred otherwise ASA(75-325mg) or ASA-clopidogrel 1 Low-moderate 1.5% (1)over Warfarin (2) over 2 Moderate 2.5% ASA/clopidogrel (3) over ASA (4) 3 High 5% 4 Very high 7%-18% Chest 2012;141(2)(Suppl):e531S-e575S AHA/ACC/HRS Guidelines CHA2DS2-VASc Score Treatment 0 No therapy preferred 1 Nothing, aspirin or oral anticoagulant 2 Warfarin,apixaban, dabigatran or rivaroxaban all equally recommended Chest 2012;141(2)(Suppl):e531S-e575S FLORIDA ASCP 14 5

6 Issues for Pharmacists Caring for the Elderly Agent CrCl > 50mL/min Renal Function CrCl ml/min CrCl ml/min 150mg BID 150mg BID 75mg BID CI Rivaroxaban 20mg QD 15mg QD 15mg QD CI Apixaban 5mg BID N/A* N/A* CI CrCl< 15mL/min *Apixaban o2.5mg po BID if at least 2 of the following: age 80 years, 60kg or SCr 1.5mg/dL Capsule Side Effects All agents: bleeding : GI (dyspepsia, gastritis) 21% discontinuation rate in clinical trials Coat Pellet Tartaric Acid Core Seal Coating Drug Interactions o P glycoprotein inhibitors not likely clinically important Rivaroxaban/apixaban o Drugs that are combined CYP 3A4 and P-glycoprotein inhibitors may be an issue Ketoconazole, fluconazole Ritonavir Clarithromycin, erythromycin o Avoid rivaroxaban/decrease apixaban to 2.5mg BID o Drugs that are combined CYP 3A4 and P-glycoprotein inducers may be an issue Carbamazepine Phenytoin o Avoid both rivaroxaban and apixaban Black Box Warning (A)PREMATURE DISCONTINUATION OF [ANY ANTICOAGULANT] INCREASES THE RISK OF THROMBOTIC EVENTS Premature discontinuation of any oral anticoagulant, increases the risk of thrombotic events. If anticoagulation with is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. LTC Pharmacist Monitoring Considerations CBC Stool guaiac (infrequently) Renal function S/S bleeding, stroke Pharmacokinetic and pharmacodynamic drug interactions o Modify bleeding risk Minimize fall risk o Education for close CNS monitoring after a fall 6

7 Other Considerations Keep dabigatran in original blister pack o No pillbox storage or repackaging Don t break, chew or open dabigatran Take rivaroxaban with food Can crush rivaroxaban and mix with applesauce or give through G-tube Monthly Cost Warfarin: $4/month, $10/3 months o ~$80/month including INR checks Pradaxa: $260/month Xarelto: $260/month Eliquis: $260/month Cost Effectiveness Recent data supports all 3 NOAC agents are more cost-effective than warfarin <$50,000 per quality-adjusted life year (QALY) is generally considered cost-effective o Rivaroxaban: $3190/QALY o : $11150/QALY o Apixaban: $15026/QALY Coverage Rivaroxaban is covered on 90% of Medicare Part D plans and 99% of commercial plans in Florida is covered on 95% of Medicare Part D plans and commercial plan in Florida Apixaban data not readily available but appears to be similar Deitelzweig, et al. J Med Econ. 2012;15: Pink, et al. Clin Pharmacol Ther. 2013;94: HAS-BLED Score Bleeding Considerations Risk Score for Predicting Bleeding in Anticoagulated Patients with Atrial Fibrillation Weight (points) Hypertension (> 160 mm Hg systolic) 1 Abnormal renal or hepatic function 1-2 Stroke 1 Bleeding history or anemia 1 Labile INR (TTR < 60%) 1 Elderly (age > 75 years) 1 Drugs (antiplatelet, NSAID) or alcohol 1-2 High risk (> 4%/year) > 4 Moderate risk (2-4%/year) 2-3 Low risk (< 2%/year) 0-1 Pisters R, et al. Chest 2010; 138: Lip GYH, et al. J Am Coll Cardiol 2010; 57:

8 Management of Bleeding - Warfarin Minor ohold/omit dose. Vitamin K in some cases. Major/life-threatening Kcentra (4 factor PCC) OR FFP + Vitamin K Management of Bleeding on Novel Agents Mild bleeding Delay next dose or discontinue treatment as appropriate FFP ineffective Vitamin K ineffective Patients with bleeding on NOAC therapy Moderate-Severe bleeding Mechanical compression Fluid replacement and hemodynamic support Blood product transfusion Oral charcoal (dabigatran) Hemodialysis (dabigatran) Prothrombin Complex Concentrate 4 factor (rivaroxaban, apixaban) (Circulation 2011; 2011: 124: ) Life-threatening bleeding Mechanical compression Fluid replacement and hemodynamic support Consideration of rfviia or apcc Charcoal (dabigatran) Prothrombin Complex Concentrate - 4 factor (rivaroxaban, apixaban) (Circulation 2011; 2011: 124: ) Hankey GJ and Eikelboom JW. Circulation. 2011; 123: Known Issues with Novel Agents No established monitoring parameters No known therapeutic ranges Unknown risk of non-compliance Lack of a proven antidote Uncertain management of bleeding No head-to-head comparisons of new agents Not all populations studied adequately Long term safety? Warfarin Will Survive Established efficacy Low cost Long track record Anticoagulation clinics that maintain TTR > 60% Genetic testing on the horizon Point of care testing validated as safe and effective INR testing Q12 weeks if stable, though would not recommend this in LTC Selection Criteria Consider novel agents o Unstable INRs on warfarin (unrelated to non-compliance) o Difficulty or hardship with INR monitoring o CrCl > 30 ml/min o History of good medication compliance o High stroke risk or intracranial hemorrhage risk o Prescription coverage Consider/continue warfarin o Consistently therapeutic INRs o Valve replacement o Renal dysfunction CrCl < 15 ml/min o History of GI bleeding o Medication non-compliance (?) o No prescription coverage Which NOAC for Your Resident? All agents are likely equally effective Apixaban may be safer than others for those > 75 years, though this is not well established o Likely the case in those with a history of or risk for GI bleeding is most reliant on renal function for clearance is most likely to cause intolerable GI side effects Rivaroxaban was studied in the highest risk AFIB patients Coverage 8

9 Case RY is a 72 year old resident with CHF, CAD, HTN, GERD and AFIB. He was recently placed in the nursing home due to decline in ADLs and IADLs. He has been diagnosed with cognitive impairment and his spouse is unable to care for him due to her own health limitations. Medications Labs Lisinopril 10mg QD Na 133 BUN 23 Carvedilol 12.5mg BID K 4.2 SCr 1.2 Aspirin 325mg QD Cl 99 Glu 109 Atorvastatin 20mg QD CO2 22 Hgb 12 Omeprazole 20mg QD BP: 119/72 P: 77 EKG: AFIB Questions 1. Is this resident a candidate for anticoagulation? 2. What is this resident s bleeding risk? 3. Which anticoagulant would you choose? Why? What do guidelines recommend? 4. Regardless of choice, what are you going to monitor with your monthly chart reviews? Thank you for your attention! 9

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

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 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

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

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

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

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

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

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

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

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

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

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

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

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

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

More information

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

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

More information

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

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

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

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

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

More information

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

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

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

More information

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

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

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

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

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

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

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

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

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 Oral Anticoagulants. Pharmacological considerations

New Oral Anticoagulants. Pharmacological considerations New Oral Anticoagulants Pharmacological considerations New oral anticoagulants The ideal anticoagulant. Metabolic pathways Drug-drug interactions One dose fits all??? Special sub-groups of patients. NOAC

More information

Atrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR

Atrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR Atrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR Disclosures None relevant to this presentation Outline Introduction Natural History and Stroke Risk Stroke/Bleeding

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

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

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

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

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

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

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

More information

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

Dorset Cardiac Centre

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

More information

Learning Objectives Novel Oral Anticoagulants in the Geriatric Patient: To Bleed or Not to Bleed

Learning Objectives Novel Oral Anticoagulants in the Geriatric Patient: To Bleed or Not to Bleed Learning Objectives Novel Oral Anticoagulants in the Geriatric Patient: To Bleed or Not to Bleed Jonathan D. Edwards, Pharm.D., BCPS, CGP Huntsville Hospital Department of Pharmacy Huntsville, Alabama

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

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

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

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

CCPN SPAF Tool. www.ccpn.ca STROKE PREVENTION IN ATRIAL FIBRILLATION (SPAF): POCKET REFERENCE

CCPN SPAF Tool. www.ccpn.ca STROKE PREVENTION IN ATRIAL FIBRILLATION (SPAF): POCKET REFERENCE SEPTEMBER 2012 CCPN SPAF Tool STROKE PREVENTION IN ATRIAL FIBRILLATION (SPAF): POCKET REFERENCE Approximately 20% of all strokes are attributable to Atrial Fibrillation (AF). 1 Of these, 20% will result

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

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

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

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

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

What You Should NOAC About the New Anticoagulants. Dr Calum Young Cardiologist

What You Should NOAC About the New Anticoagulants. Dr Calum Young Cardiologist What You Should NOAC About the New Anticoagulants Dr Calum Young Cardiologist Overview The Burden of AF What s Wrong With Warfarin? The Era of NOACs NOACs in New Zealand Clinical Trials with NOACs Potential

More information

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

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

More information

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

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

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

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

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

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

More information

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

Atrial Fibrillation: Stroke and Thromboprophylaxis. Derek Waller

Atrial Fibrillation: Stroke and Thromboprophylaxis. Derek Waller Atrial Fibrillation: Stroke and Thromboprophylaxis Derek Waller Atrial Fibrillation in the Elderly: Risk of Stroke Framingham study AGE 50-59 60-69 70-79 80-89 Prevalence of AF % Attributable Risk of AF

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

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

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

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

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

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

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

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

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: 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

NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST

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

More information

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

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

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

More information

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

Elisabetta Toso, MD Dipartment of Medical Sciences University of Turin

Elisabetta Toso, MD Dipartment of Medical Sciences University of Turin Security and efficacy of Rivaroxaban in real life in the prevention of the stroke in non valvular AF patients: presentation of the results of the international study Xantus Elisabetta Toso, MD Dipartment

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

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

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

Critical Bleeding Reversal Protocol

Critical Bleeding Reversal Protocol Critical Bleeding Reversal Protocol Coagulopathy, either drug related or multifactorial, is a major contributing factor to bleeding related mortality in a variety of clinical settings. Standard therapy

More information

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

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

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

AF, Stroke Risk and New Anticoagulants

AF, Stroke Risk and New Anticoagulants Carmarthen Cardiac Update Course AF, Stroke Risk and New Anticoagulants Dr Hamsaraj Shetty, B.Sc, FRCP (London & Edinburgh) Consultant Physician & Honorary Senior Lecturer University Hospital of Wales,Cardiff

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

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

NORTH WEST LONDON GUIDANCE ANTITHROMBOTIC MANAGEMENT OF ATRIAL FIBRILLATION

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

More information

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

GRASP-AF Coming to a PCT near you.

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

More information

Managing Anticoagulation for Atrial Fibrillation 2015

Managing Anticoagulation for Atrial Fibrillation 2015 Managing Anticoagulation for Atrial Fibrillation 2015 Vikranth Gongidi, DO FACC FACOI Indian River Medical Center Vero Beach, FL Atrial Fibrillation Background and Guidelines Decisions to anticoagulate

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

1/12/2016. What s in a name? What s in a name? NO.Anti-Coagulation. DOACs in clinical practice. Practical aspects of using

1/12/2016. What s in a name? What s in a name? NO.Anti-Coagulation. DOACs in clinical practice. Practical aspects of using What s in a name? Practical aspects of using DOACs (Direct Oral Anticoagulants) James L. Sebastian, MD, MACP Professor of Medicine (GIM) Medical College of Wisconsin February 5, 2016 DOAC NOAC NOAC ODI

More information

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

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

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

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

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

More information

A case-based approach to implementing guidelines for stroke prevention in patients with atrial fibrillation: balancing the risks and benefits

A case-based approach to implementing guidelines for stroke prevention in patients with atrial fibrillation: balancing the risks and benefits Amin and Deitelzweig Thrombosis Journal (2015) 13:29 DOI 10.1186/s12959-015-0056-y REVIEW A case-based approach to implementing guidelines for stroke prevention in patients with atrial fibrillation: balancing

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

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

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