Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014

Size: px
Start display at page:

Download "Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014"

Transcription

1 Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014

2 Atrial Fibrillation 2

3 Atrial Fibrillation The most common arrhythmia encountered in clinical practice. The prevalence increases with age. Risk factors include HPTN, valvular heart disease, cardiomyopathy, obesity, sleep apnea, congenital heart disease, pulmonary disease, & hyperthyroidism. Classified as paroxysmal, persistent, or permanent. Major complications include CHF & stroke. 3

4 LAA Thrombus 4

5 AF - CASE STUDIES 45 yr old male. No significant PMH. Develops AF while training for a marathon. He presents to the ER & then spontaneously converts to SR after 6 hrs. Baseline ECG & Echo are normal. 76 yr old female with HPTN, NIDDM who presents to her PCP for an annual checkup is found to be in AF with a controlled ventricular response. She is completely unaware that she is in AF. She has a history of GI hemorrhage within the past year. 68 yr old male with previous CABG, CHF, HPTN, & AS presents to the ER with a 2 day history of palpitations. He is found to be in AF with a RVR. He is admitted to the hospital & started on IV diltiazem for rate control. 5

6 CHADS2 Go AS, Hylek EM, Chang Y, et al. JAMA 2003; 290:2685 6

7 CHA2DS2-VASc Eur Heart J 2010; 31:2369 7

8 CHA2DS2-VASc Eur Heart J 2010; 31:2369 8

9 Warfarin Inhibits vit K dependent coagulation factors Metabolism - Liver CYP450 1/2 life 20-60h Dose adjusted to INR 2-3 Many drug & food interactions Common drugs that increase the INR - Quinolones, Erythromycins, Tetracyclines antifungals, Isoniazid, Amio, Propafenone, Gemfibrizol, Niacin,Pantoprozole, Paroxitene, Rouvastatin 9

10 Dabigatran (Pradaxa) Direct thrombin inhibitor Indicated for the prevention of stroke & thromboembolism in nonvalvular AF No liver CYP 450 metabolism; Primarily urine excretion 1/2 life hrs CrCl >50 ml/min - dose 150mg bid CrCl ml/min - dose 75 mg bid 10

11 Drugs that Increase Dabigatran Levels Cyclosporin Dronedarone Antifungal agents - Itraconazole & Ketoconazole Quinidine Verapamil 11

12 Drugs That Decrease Dabigatran Levels Carbamazepine Rifampin St. John s Wort 12

13 RE-LY Comparison of Dabigatran (150 mg bid & 110 mg bid) with warfarin in pts with nonvalvular AF & risk of stroke. Randomized, blinded for dabigatran, unblinded for warfarin Primary outcome was stroke or systemic embolization Median duration of F/U - 2 years N Engl J Med 2009; 361:

14 RE-LY Efficacy outcomes according to treatment group N Engl J Med 2009; 361:

15 RE-LY Cumulative hazard rates for stroke or systemic embolization according to treatment group. N Engl J Med 2009; 361:

16 RE-LY Safety outcomes N Engl J Med 2009; 361:

17 Concomittant Use of Antiplatelet in the RE-LY Trial Circulation. 2013;127:

18 Periprocedural Bleeding in the RE-LY Trial Circulation. 2012;126:

19 Periprocedural Bleeding in the RE-LY Trial Circulation. 2012;126:

20 RE-ALIGN Dabigatran vs warfarin S/P AVR & MVR within 7 days & after 3 months. Dabigatran dose 150, 220, 300mg bid based on renal function. The trial was terminated prematurely due to an excess of thromboembolic & bleeding events in the dabigatran group. N Engl J Med 2013;369:

21 Rivaroxaban (Xarelto) Factor Xa inhibitor Indicated for the prevention of stroke & thromboembolism in nonvalvular AF. Also indicated for the prevention & tx of DVT/PE. Metabolism - Liver CYP450; Urinary excretion 66% 1/2 life 5-9 hrs; hrs in the elderly CrCl >50 ml/min - dose 20 mg daily CrCl ml/min - dose 15 mg daily 21

22 Drugs That Increase Rivaroxaban Levels Amiodarone, Dronedarone Erythromycins Cyclosporine Diltiazem Antifungal agents - Itraconazole & Ketoconazole Phenytoin Ranolazine Tamoxifen Verapamil 22

23 Drugs That Decrease Rivaroxaban Levels Carbamazepine Phenytoin Rifampin St. John s Wort 23

24 ROCKET AF Comparison of Rivaroxaban (20 mg daily) vs warfarin (INR 2-3) in pts with nonvalvular AF. Randomized, double blind design. Primary endpoint - stroke or systemic embolization. N Engl J Med 2011;365:

25 ROCKET AF The Rivaroxaban group had 21% reduction in stroke & systemic embolization. Incidence of major bleeding was similar - Rivaroxaban (14.9%) vs warfarin (14.5%). The Rivaroxaban group had significantly less intracranial hemorrhage (0.5% vs 0.7%) & fatal hemorrhage (0.2% vs 0.5%). N Engl J Med 2011;365:

26 ROCKET AF N Engl J Med 2011;365:

27 ROCKET AF N Engl J Med 2011;365:

28 ROCKET AF J Am Coll Cardiol 2013;61:

29 ROCKET AF The mean time in therapeutic range in the warfarin group was 55.2%. The mean time with an INR <2 was 29.1%. The mean time with an INR >3 was 15.7%. J Am Heart Assoc. 2013;2:e doi /JAHA

30 Apixaban (Eliquis) Factor Xa inhibitor Indicated for the prevention of stroke & thromboembolism in nonvalvular AF Metabolism - Liver CYP450; Urine excretion 27% 1/2 life 12 hrs Dose 5 mg bid Creat >1.5, age >80, wt <60 kg - dose 2.5 mg bid 30

31 Drugs That Decrease Apixaban Levels Dexamethasone Nafcillin Phenobarbital Phenytoin Rifampin St. John s Wort 31

32 ARISTOTLE Apixaban vs Warfarin in pts with AF Randomized, double blind trial design Pts had at least 1 additional RF for stroke Primary outcome: stroke or systemic embolization Median duration of F/U years 32

33 ARISTOTLE N Engl J Med 2011;365:

34 ARISTOTLE N Engl J Med 2011;365:

35 AVERROES Apixaban vs ASA in pts with AF Double blind, randomized design Mean F/U 1.1 years The primary outcome was stroke or systemic embolization N Engl J Med 2011;364:

36 AVERROES N Engl J Med 2011;364:

37 AVERROES N Engl J Med 2011;364:

38 LAA Occlusion Devices 38

39 PROTECT AF Comparison of a LAA closure device (Watchman) with warfarin for the prevention of stroke & systemic embolization in pts with nonvalvular AF & at least 1 risk factor. After device implantation, pts received warfarin for 45 days, followed by clopidogrel for 4.5 months & then life long ASA. Mean F/U 2.3 yrs. Composite endpoint - stroke, systemic embolization, & CV death. Primary composite endpoint in the Watchman group (3%) was equivalent to the warfarin group (4.3%). Circulation.2013;127:

40 PROTECT AF Circulation.2013;127:

41 ASAP Study Evaluation of the Watchman LAA closure device in pts with nonvalvular AF ineligible for warfarin. 150 pts with nonvalvular AF & CHADS2 score at least 1 Primary efficacy end point was the combined events of ischemic stroke, hemorrhagic stroke, systemic embolization, CV / unexplained death. J Am Coll Cardiol 2013;61:

42 ASAP Study Pts with LVEF <30%, intracardiac thrombus, dense spontaneous echo contrast on TEE, PFO, significant mitral stenosis, pericardial effusion >3 mm, mobile plaque in the ascending aorta or aortic arch were excluded. Following implant, pts received 6 months of clopidogrel or ticlopidine followed by life long ASA. The mean CHADS2 score was 2.8. Mean f/u 14.4 months. J Am Coll Cardiol 2013;61:

43 ASAP Study The expected rate of ischemic stroke for pts treated only with ASA was 7.3%. J Am Coll Cardiol 2013;61:

44 THE WATCHMAN LAA OCCLUSION DEVICE 44

45 Cryoablation for AF 45

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

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

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

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

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

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

New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013

New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7

More information

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

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

More information

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

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

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

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

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

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

Antiplatelet and Antithrombotics From clinical trials to guidelines

Antiplatelet and Antithrombotics From clinical trials to guidelines Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories

More information

Anticoagulation 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

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

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

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

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

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

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

Time of Offset of Action The Trial

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

More information

Practical everyday use of NOACs. Dr. Elisabetta Toso SOC Cardiologia Ospedale Cardinal Massaia - Asti

Practical everyday use of NOACs. Dr. Elisabetta Toso SOC Cardiologia Ospedale Cardinal Massaia - Asti Practical everyday use of NOACs Dr. Elisabetta Toso SOC Cardiologia Ospedale Cardinal Massaia - Asti THE NEW ANTICOAGULANTS HISTORY Oral Inhibitors Edoxaban Apixaban Betrixaban EXPLORE-Xa Phase II trial

More information

Cardiovascular Disease

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

More information

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

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

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

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

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

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

Efficacy in Hip Arthroplasty. Efficacy in Knee Arthroplasty. Adverse Effects. Drug Interactions Objectives Just for the RECORD: Rivaroxaban joins the US Anticoagulation Arsenal Anne P. Spencer, PharmD, FCCP, BCPS (AQ Cardiology) Cardiovascular Care Pharmacy Specialist Roper Saint Francis Healthcare

More information

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

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

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

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

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

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

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

New Oral Anticoagulants

New Oral Anticoagulants Disclosures The New Oral Anticoagulants: Are they better than Warfarin? Alan P. Agins, Ph.D. does not have any actual or potential conflicts of interest in relation to this CE activity. Alan Agins, Ph.D.

More information

Cardiac Sources of Stroke. Robert N. Piana, M.D. Professor of Medicine Director, Adult Congenital Interventional Cardiology

Cardiac Sources of Stroke. Robert N. Piana, M.D. Professor of Medicine Director, Adult Congenital Interventional Cardiology Cardiac Sources of Stroke Robert N. Piana, M.D. Professor of Medicine Director, Adult Congenital Interventional Cardiology Stroke Pathophysiology Cardiologists Well Suited to Help 795K CVA per year, 87%

More information

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

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

More information

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

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

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

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

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

Translating clinical evidence into real-world outcomes

Translating clinical evidence into real-world outcomes Annual Swiss Stroke Society Meeting 31st of January 2013 Symposium: From RE-LY to practice: Changing the attitude on stroke prevention in AF Translating clinical evidence into real-world outcomes Unité

More information

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

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

More information

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

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

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

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

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

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

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

New Anticoagulants. Stroke Prevention in AF Commencing Novel Oral Anticoagulants (NOACs) in the GP Setting. 30-Oct-14

New Anticoagulants. Stroke Prevention in AF Commencing Novel Oral Anticoagulants (NOACs) in the GP Setting. 30-Oct-14 Stroke Prevention in AF Commencing Novel Oral Anticoagulants (NOACs) in the GP Setting A/Prof Michael Nguyen Fremantle Hospital Access Cardiology General Practice Education Day Oct 2014 ORAL TTP889 Rivaroxaban

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

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

Management for Deep Vein Thrombosis and New Agents

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

More information

Prevention of thrombo - embolic complications

Prevention of thrombo - embolic complications Update on atrial fibrillation Prevention of thrombo - embolic complications Felicita Andreotti Dept of Cardiovascular Science Catholic University, Rome, IT Consultant or speaker in past 2 years for Amgen,

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

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

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

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

Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology

Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of

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

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

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 2013 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

Stacey Moultrie, PharmD ROCKET-AF 1. "Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation" 1

Stacey Moultrie, PharmD ROCKET-AF 1. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation 1 Stacey Moultrie, PharmD ROCKET-AF 1 I. Introduction: (1-4) "Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation" 1 ROCKET-AF: The Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared

More information

The New Kids on the Block: Oral Anticoagulants

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

More information

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

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

Frederik Meijer Heart & Vascular Institute

Frederik Meijer Heart & Vascular Institute Frederik Meijer Heart & Vascular Institute Evaluation of Atrial Fibrillation in the Outpatient Setting Musa I Dahu, MD, FHRS Electrophysiology Frederik Meijer Heart & Vascular Institute Clinical Assistant

More information

Breadth of indications matters One drug for multiple indications

Breadth of indications matters One drug for multiple indications Breadth of indications matters One drug for multiple indications Sylvia Haas, MD, PhD Formerly of the Technical University of Munich Munich, Germany Disclosures: Sylvia Haas 1 Novel oral anticoagulants:

More information

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

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

The author has no disclosures

The author has no disclosures Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author

More information

New 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

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

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

More information

Management of Antithrombotics with Procedures. Jordan Weinstein, MD

Management of Antithrombotics with Procedures. Jordan Weinstein, MD Management of Antithrombotics with Procedures Jordan Weinstein, MD Presenter Disclosure Information Cardiology Update 2013 I have no relevant financial interest and/or arrangement with industry. Novel

More information

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

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

More information

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

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

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

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

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

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

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

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

More information

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

Secondary Stroke Prevention. Lawrence R. Wechsler, M.D.

Secondary Stroke Prevention. Lawrence R. Wechsler, M.D. Secondary Stroke Prevention Lawrence R. Wechsler, M.D. Outline Risk factor modification Antiplatelet therapy Anticoagulation Intracranial stenosis PFO and stroke Risk Factor Control Hypertension - < 140/90,

More information

Atrial Fibrillation and Stroke Integris Stroke Conference 2015

Atrial Fibrillation and Stroke Integris Stroke Conference 2015 Integris Cardiovascular Physicians Atrial Fibrillation and Stroke Integris Stroke Conference 2015 Sean M. Halleran, MD, FACC, FHRS Clinical Cardiac Electrophysiology Disclosures Pfizer, Bristol Myers Squibb

More information

Target-Specific Oral Anticoagulants: A review for cardiovascular practitioners

Target-Specific Oral Anticoagulants: A review for cardiovascular practitioners Target-Specific Oral Anticoagulants: A review for cardiovascular practitioners Beena Cheriyan, PharmD Clinical Pharmacy Specialist Cardiology St. Joseph Mercy Hospital Ann Arbor February 19th, 2015 2 Disclosure

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

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

Traditional anticoagulants

Traditional anticoagulants TEGH Family Practice Clinic Day April 4, 03 Use of Anticoagulants in 03: What s New (and What Isn t) Bill Geerts, MD, FRCPC Director, Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University

More information

Atrial fibrillation How is treatment changing? Charles Henrikson, MD Director, Electrophysiology Service 1 February 2014

Atrial fibrillation How is treatment changing? Charles Henrikson, MD Director, Electrophysiology Service 1 February 2014 Atrial fibrillation How is treatment changing? Charles Henrikson, MD Director, Electrophysiology Service 1 February 2014 Outline Introduction Natural history of afib and stroke Current risk stratification

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

Turn the Beat Around-Remix: Atrial Fibrillation Guidelines-2014 Updates

Turn the Beat Around-Remix: Atrial Fibrillation Guidelines-2014 Updates Turn the Beat Around-Remix: Atrial Fibrillation Guidelines-2014 Updates Brittany Karns, PharmD Alaska Pharmacists Association Annual Conference - 2015 Disclosures I have no actual or potential conflicts

More information

Anti Coagulation for Stroke Prevention in Atrial Fibrillation The Case for Coumadin vs. NOACS

Anti Coagulation for Stroke Prevention in Atrial Fibrillation The Case for Coumadin vs. NOACS Anti Coagulation for Stroke Prevention in Atrial Fibrillation The Case for Coumadin vs. NOACS Cardiac Electrophysiology, Cardiology Department Meir Medical Center מודיעין על היריב ד"ר לילך דולב אחראית

More information