New Oral Antithrombotics and Their Emergent Reversal Part 1
|
|
- Basil Malone
- 8 years ago
- Views:
Transcription
1 New Oral Antithrombotics and Their Emergent Reversal Part 1 Christian Hamm, PharmD, BCPS christian.hamm@multicare.org Allison Massingill, PharmD allison.massingill@multicare.org 1
2 Disclosures No relevant financial relationships exist. 2
3 Objectives Introduce the new oral anticoagulants (NOACs): dabigatran, rivaroxaban, apixaban, edoxaban, and betrixaban Introduce the new oral antiplatelets: prasugrel, ticagrelor, and vorapaxar Describe the incidence, morbidity and mortality associated with oral antithrombotic-related bleeding Discuss contemporary reversal strategies for these drugs Explain associated costs and risks involved with the reversal agents 3
4 FDA approval history of anticoagulants edoxaban 2015 heparin 1939 warfarin 1954 enoxaparin & lepirudin 1998 dalteparin 1999 fondaparinux 2001 argatroban & bivalirudin 2000 rivaroxaban 2011 dabigatran 2010 apixaban
5 What are some ideal properties in an anticoagulant? Safe (low bleeding risk) Effective (in reducing thromboembolic events) Rapid onset (avoid the need for bridging) Optimal duration of action (ideally once daily dosing) Minimal food/drug interactions Simple therapeutic monitoring Ability for rapid reversal 5
6 Which of the following are associated with reduced rates of intracranial bleedings compared with warfarin? dabigatran apixaban rivaroxaban edoxaban 6
7 Which of the following are associated with reduced rates of intracranial bleedings compared with warfarin? ALL OF THEM dabigatran: 0.3% dabigatran vs 0.7% warfarin apixaban: 0.3% apixaban vs 0.8% warfarin rivaroxaban: 0.8% rivaroxaban vs 1.2% warfarin edoxaban: 0.5% edoxaban vs 1% warfarin 7
8 Which of the following are superior to warfarin for the reduction of ischemic stroke in nonvalvular a fib? dabigatran rivaroxaban apixaban edoxaban 8
9 Which of the following are superior to warfarin for the reduction of ischemic stroke in nonvalvular a fib? dabigatran: 0.92% dabigatran vs 1.2% warfarin (P = 0.002) rivaroxaban: 2.1% rivaroxaban vs 2.4% warfarin (P < 0.001) apixaban: 1.19% apixaban vs 1.51% warfarin (P =0.01) edoxaban: 1.18% edoxaban vs 1.5% warfarin (P < 0.001) 9
10 Which of the following drugs require bridging with a LMWH for a fib? dabigatran rivaroxaban NONE apixaban edoxaban 10
11 Which of the following require bridging with a LMWH for DVT/PE treatment? dabigatran rivaroxaban apixaban edoxaban 11
12 Which of the following requires bridging with a LMWH for DVT/PE treatment? dabigatran rivaroxaban apixaban Both require 5 to 10 days of parenteral anticoagulation edoxaban 12
13 The Clotting Cascade Accessed October 10,
14 Where in the clotting cascade does dabigatran work?? Accessed October 10,
15 The Clotting Cascade Accessed October 10,
16 Dabigatran 1st oral direct thrombin inhibitor 1st new oral anticoagulant in over fifty years Stroke prevention in a fib: 150mg PO BID No need for bridging for a fib (time to peak 1 hour) For poor kidneys (CrCl ml/min): 75mg PO BID DVT/PE treatment:150mg PO BID after 5-10 days of parenteral anticoagulation Drug interactions? Do not use with strong PGP inhibitor (eg, amiodarone, dronedarone, clarithromycin, cyclosporine, ritonovir, quinidine, tacrolimus, verapamil) and if CrCl < 50 ml/min /02/pradaxa.jpg. Accessed Nov 10, 2014
17 Can I monitor dabigatran with a lab test? What if I order a PT or PTT? Both will be elevated at therapeutic doses But it can serve to know if the patient has some drug in the body What is Dilute Thrombin Time? developed to monitor direct thrombin inhibitors. Better sensitivity than PTT. Cost/Turnaround time similar to PTT. How is it used? Assure absence of drug prior to invasive procedures (e.g., LP, or chest tube placement) Assure absence of drug prior to use of thrombolytic therapy Less likely to be useful for: assessing compliance assessing possible over-anticoagulation in hemorrhage assessing possible under-anticoagulation in treatment failure Love J, Ferrell C, Chandler W. Monitoring direct thrombin inhibitors with a plasma diluted thrombin time. Thromb Haemost 2007; 98:
18 Which of the following has a once daily dosing for atrial fib? dabigatran rivaroxaban apixaban edoxaban 18
19 Which of the following has a once daily dosing for atrial fib? dabigatran rivaroxaban apixaban edoxaban 19
20 Which of the following has a once daily dosing for DVT/PE treatment? dabigatran rivaroxaban apixaban edoxaban 20
21 Which of the following has a once daily dosing for atrial fib? DVT/PE treatment? dabigatran rivaroxaban apixaban edoxaban 21
22 Where in the clotting cascade does rivaroxaban work?? Accessed October 10,
23 Where Does rivaroxaban work? Accessed October 10,
24 Rivaroxaban First oral direct Factor Xa inhibitor Time to peak 2-4 hours. No need for bridging. Several indications: DVT prophylaxis in post-op knee and hip replacements (want to start 6-10 hours post-op):10mg PO daily x days for knees and 10mg PO daily x days for hips Stroke prevention in a fib: 20mg PO daily DVT/PE treatment: 15mg PO BID x 3 weeks then 20mg PO daily Drug interactions? worry about P-gp and 3A4 inhibitors, but no dose adjustment recommended 24 Accessed November 11, 2014.
25 How do I monitor rivaroxaban with a lab test? What if I order a PT or PTT? Both will be elevated at therapeutic doses But it can serve to know if the patient has some drug in the body How about ordering a rivaroxaban drug level? If available. A fib VTE Tx VTE Prophy laxis Anti-Xa activity test used to extrapolate rivaroxaban concentrations. How is it used? Assure absence of drug prior to invasive procedures Peak level ng/ ml ng/ ml ng/ ml Assure absence of drug prior to use of thrombolytic therapy Less likely to be useful for: Trough level 4-6 ng/ml ng/ml ng/ml assessing compliance assessing possible over-anticoagulation in hemorrhage assessing possible under-anticoagulation in treatment failure Francart S, Hawes E, Deal, A, et al. Performance of coagulation tests in patients on therapeutic doses of rivaroxaban. Thromb Haemost 2014; 111: Accessed October 12,
26 Rivaroxaban case #1 GF is 69 yo M who presents to the ED with cc of fever, chills, nausea. History of DM2, NSTEMI with CABG three weeks prior. This AM he began coughing, with CP and SOB. He is also slightly altered - not oriented to month or year. Initial vitals are BP=153/62, HR = 110, RR = 20 O2Sat = 96% RA, Temp = 103 (oral) Home meds: aspirin, glipizide, HCTZ, glargine, lisinopril, metformin, metoprolol, ranitidine, simvastatin, tramadol, EKG today: unchanged from discharge three weeks ago Labs: CBC, CMP, troponin, UA, lactate - all normal; D-Dimer - not ordered CXR: normal CT ANGIO LUNG: Findings of a very small non-occlusive pulmonary embolism within a subsegmental branch in the anterior segment of the left upper lobe. Plan: CT surgery is paged -> start enoxaparin & warfarin -> ED doc puts in those orders -> After reviewing patient I cannot find any contraindications to rivaroxaban and call back CT surg to get enoxaparin/warfarin switched to rivaroxaban. Hopefully thereby decreasing hospital admission time and simplify drug therapy for the patient. 26
27 Rivaroxaban case #2 CF is a 61 yo M who is brought to the ED for heart palpitations and weakness. He began having malaise about two weeks ago, but after being in bed for two days now is seeking medical help. PMH: DVT& PE earlier this year (was on warfarin for 6 months) ECG: a fib with rapid ventricular response in the 180s, also with runs of non-sustained wide complex beats. Vitals: HR 187, Bp 104/85, RR 17, O2 Sat 98% on RA Patient is rushed to CT for CTA of his chest to r/o PE 27
28 Rivaroxaban case #2 CT demonstrates massive bilateral PE Doc asks me if this a good rivaroxaban candidate. What is your response? 28
29 Apixaban Direct Factor Xa inhibitor No need to bridge. Time to peak: 3-4 hours Several indications: DVT prophylaxis in post-op knee and hip replacements (start hrs post-op) 2.5mg PO BID x 12 days for knees 2.5mg PO BID x 35 days for hips Stroke prophylaxis in nonvalvular a fib 5mg PO BID Reduce dose to 2.5mg PO BID if patient has any 2 of the following: age > 80, weight< 60kg or Scr > 1.5 DVT/PE treatment 10mg PO BID x 7 days then 5mg PO BID Drug interactions: dose reduce for concurrent dual strong P-gp and 3A4 inhibitors (e.., ketoconazole, ritonivir) Pregnancy category: B 29 uploads/eliquis-5mg-box_bottle.jpg. Accessed
30 Apixaban case JH is a 84 yo F who presents to the ED with a cc of CP and her heart beating out of her chest. She has a hx of HTN, CKD stage 4. and OA. Her CP has been going on for several days now. Initial vitals: HR= 150, BP = 146/87, RR = 24, 02Sat = 93% RA, Temp 99 (oral) Home meds: ramipril, chlorthalidone, and ibuprofen CXR: normal Labs: CBC, CMP, TSH, troponin D-Dimer - all normal except for Scr of 1.8 (unchanged from baseline two months ago). EKG: a fib with rvr (rate of 150) Plan: new onset a fib -> cardiology consult. They recommend apixaban 5mg PO BID. She is > 80 and Scr > 1.5 -> call back cardiology to get dose reduced to 2.5mg PO BID 30
31 How do I monitor apixaban with a lab test? What if I order a PT or PTT? Both will be elevated at therapeutic doses But it can serve to know if the patient has some drug in the body How about ordering an apixaban drug level? If available. A fib VTE Tx VTE Prophy laxis Anti-Xa activity test to extrapolate apixaban concentrations. How is it used? Peak level ng/ml ng/ml ng/ml Assure absence of drug prior to invasive procedures Assure absence of drug prior to use of thrombolytic therapy Less likely to be useful for: Trough level ng/ml ng/ml ng/ml assessing compliance assessing possible over-anticoagulation in hemorrhage assessing possible under-anticoagulation in treatment failure Francart S, Hawes E, Deal, A, et al. Performance of coagulation tests in patients on therapeutic doses of rivaroxaban. Thromb Haemost 2014; 111: Accessed May 7,
32 Edoxaban Direct Factor 10a inhibitor Indications: Atrial fib: No bridging necessary for afib. Time to peak ~ 3 hours. 60mg PO daily (for Cr Cl ml/min) 30mg PO daily (for Cr Cl ml/min) Contraindication: Do not use if Cr Cl > 95 ml/min (greater than, not less than) due to increased risk of stroke. In Engage AF-TIMI 48 study, patients had an increased rate of ischemic stroke with edoxaban 60mg daily compared to patients on warfarin. In these patients, another anticoagulant should be used. Raises question: perhaps this is best NOAC in a fib for patients with poor kidney function? DVT/PE treatment: 60mg PO daily after 5-10 days of parenteral anticoagulation (just like dabigatran for this indication) Dose reduce to 30mg PO daily if (Cr Cl 15-50ml/min or weight < 60kg or taking certain pg. inhibitors) 32
33 Direct 10a inhibitor Currently in Phase 3 Trial Betrixaban Trying to be first anticoagulant approved for both in hospital and post discharge VTE prevention in acute medically ill patients (such as CHF, stroke, infection, pulmonary disease.) Game changer. No longer will patients be getting enoxaparin or SQ heparin for DVT prophylaxis -> medical patients get an oral med First thrombosis study to identify those at highest risk for a DVT and most likely to benefit from betrixaban: targeting patients with an elevated D-Dimer levels and those over age > 75 Betrixaban for up to 35 days vs enoxaparin for up to 14 days. Simultaneous development by the drug company, Portolo, of a reversal agent for betrixaban called andexanet. This reversal agent also being studied to reverse rivaroxaban, apixaban, and edoxaban Accessed November 12, 2014
34 Shifting gears Accessed 5/2/
35 The platelet It is a major therapeutic target It is of central importance to cardiovascular disease No other single cell is responsible for as much morbidity and mortality as the platelet Still searching for a magic bullet that selectively targets pathological thrombus formation without undermining hemostasis Can you name the various pathways drugs can block platelet aggreagation? Accessed October 12,
36 Platelet activation pathways 36 Accessed May 4, 2015
37 FDA approval history of antiplatelets aspirin 1906 clopidogrel ticlopidine 1997 aspirin/ 2001 dipyridamole 1999 prasugrel 2009 vorapaxar 2014 ticagrelor
38 What is clopidogrel non-responsiveness? A. I just made up the term B. defined as no clinically important change in platelet function after treatment as compared to baseline C. Only happens in Asians D. none of the above 38
39 What is clopidogrel non-responsiveness? A. I just made up the term B. defined as no clinically important change in platelet function after treatment as compared to baseline C. Only happens in Asians D. none of the above 39
40 Prasugrel Irreversible ADP (P2Y12) receptor antagonist Faster, more consistent, and greater extent of platelet inhibition as compared to clopidogrel Prodrug just like clopidogrel. Onset: < 30 min after load Indication: reduce thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) who are to be managed with PCI Dose: 60mg PO x 1 (within 1 hour of PCI) followed by 10mg PO daily in combination with aspirin mg PO daily want to continue on prasugrel for at least 12 months regardless of stent type Dose reduce to 5mg PO daily for patients < 60 kg 40 DAM/011/Effient_Bottle_10mg30ct_Main.jpg. Accessed October 13, 2014
41 Prasugrel - continued Efficacy: Primary combined endpoint of cardiovascular death, non-fatal MI, and non-fatal stroke: ~ 10% in prasugrel group vs ~12% in clopidogrel group (NNT 83) Safety: Major bleeding (by TIMI definition) 2.4% in prasugrel group vs 1.8% in clopidogrel group (NNH 167) Who should definitely NOT get prasugrel? Contraindicated in patients with hx of TIA or stroke 6.5% of prasugrel patients suffered a stroke vs only 1.2% of clopidogrel patients (NNH 19) Wiviott S, Braunwald E, McCabe C, et al. Prasugrel versus clopidogrel in patients with acute coronary syndrome. N Eng J Med 2007; 357:
42 Case - aspirin/clopidogrel LT is a 55 yo M who arrives in the ED with a chief complaint of L sided weakness onset a 0300 (now 1000am), L grip weaker than R, positive pronator drift, slurred speech, and L sided facial droop Hx of HTN, DM, and CVA - discharged from hospital 11 days ago for his first CVA. Home meds: Aspirin 81mg daily, clopidogrel 75mg daily, citalopram 40mg daily, glargine 60 units, regular insulin 10 units CC, metformin 1000mg BID, metoprolol 150mg BID, simvastatin 40mg bedtime Head CT: Positive for new ischemic stroke How should this patient be managed pharmacologically? 42
43 What maintenance dose of aspirin should be prescribed with ticagrelor? None. You re crazy. It is marketed to replace aspirin. 81mg - 325mg PO daily < 100mg PO daily > 100mg PO daily 43
44 What maintenance dose of aspirin should be prescribed with ticagrelor? None. You re crazy. It is marketed to replace aspirin. 81mg - 325mg PO daily < 100mg PO daily > 100mg PO daily 44
45 Ticagrelor Class: Cyclopentyltriazolopyrimidine, not a thienopyridine (like clopidogrel and prasugrel.) Yet still affects the P2Y12 receptor like the both of them. Onset: < 30 mins (not a prodrug, unlike clopidogrel and prasugrel) Faster, more consistent, and greater extent of platelet inhibition as compared to clopidogrel Indication: reduce thrombotic events in patients with ACS Dose: 180mg PO x 1 with aspirin 325mg followed by 90mg BID with aspirin 81mg daily (to start 12 hours after loading dose) Drug interactions: 3A4 inhibitors 45 projects/brilinta-treatment/images/1-brilintatreatment.jpg. Accessed October 15, 2014
46 Ticagrelor - continued Efficacy: primary combined endpoint of death from vascular causes, MI, or stroke. 9.8% in ticagrelor vs 11.7% in clopidogrel. (NNT 53) Safety: (TIMI definition) major non-cabg related bleeds 4.5% in ticagrelor vs 3.8% in clopidogrel (NNH 142) ICH: 0.3% ticagrelor, 0.2% clopidogrel (not stat sig) fatal ICH: 0.1% ticagrelor, 0.01% clopidogrel (stat sig) Contraindication: hx of ICH, severe hepatic impairment Side effect (counseling point): mild to moderate dyspnea - resolution usually within a week. 14% ticagrelor vs 8% (high?) clopidogrel. But only 0.9% ticagrelor required discontinuation vs 0.1% clopidogrel Wallentin L, Becker R, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndrome. N Eng J Med, 2009; 361:
47 Vorapaxar is being marketed as an alternative to what other anti-platelet agent? A. aspirin B. clopidogrel C. all of the above D. none of the above 47
48 Vorapaxar is being marketed as an alternative to what other anti-platelet agent? A. aspirin B. clopidogrel C. all of the above D. none of the above 48
49 Vorapaxar First in class protease activated receptor (PAR-1) antagonist It inhibits thrombin-induced and thrombin receptor agonist peptide (TRAP-induced) platelet aggregation Indication: Reduce thrombotic cardiovascular events in patients with a hx of MI or PAD Dose: 2.08mg PO daily IN COMBINATION with aspirin AND/OR clopidogrel This means a patient can be on 3 anti-platelet agents! Dose adjustments: caution in hepatic/renal impairment - but no dose adjustment noted Drug interactions?: 3A4 substrate, avoid use with strong 3A4 inducers/inhibitors - but no dose adjustment noted. Also PGP inhibitor Onset of action: > 80% TRAP-induced platelet aggregation within 1 week Half-life: (long) 3-4 days Accessed October 12,
50 Vorapaxar - continued Efficacy: Looked at patients with hx of MI or PAD over 3 years 1.7% absolute risk reduction of primary composite endpoint for CV death, MI, stroke, or urgent coronary revascularization -> NNT 59 (not that effective?) No experience using vorapaxar as the only anti-platelet agent. Must be used in combination with aspirin and/or clopidogrel Safety: (GUSTO definition) moderate to severe bleed absolute difference in bleeding between groups was 1.3% -> NNH 77 Two years into 3 year trial -> stopped enrolling patients with hx of stroke due to increased risk of ICH Contraindication: Do not use in patients with hx of stroke, TIA, or intracranial hemorrhage (ICH) 50
51 Take Home Points all new oral anticoagulants are at least non-inferior in efficacy to warfarin as well as being just as safe from a bleeding perspective. However, some risk factors for decreased efficacy/increased bleeding: low body weight (especially < 60 kg) decreased renal function (especially when CrCl ~ 30-50ml/min) increased age (perhaps as early as 65) drug interactions: strong CYP3A4 inhibitors/inducers; P-gp inhibitors active liver disease: avoid use in Child-Pugh B and C Anti-platelet agents: prasugrel and ticagrelor are more potent P2Y12 inhibitors as compared to clopidogrel, but at the expense of more bleeds; vorapaxar is an adjunctive agent to be used along with aspirin and/or clopidogrel Lu Y, Brandstad R, Karim R, et al. Considerations of clinical variables for choosing new anticoagulant alternatives to warfarin for the management of non-valvular atrial fibrillation. J Clin Pharm & Therapeutics, 2014; 39:
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 informationTime 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 informationUpdate 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 informationCardiovascular 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 information3/25/14. 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 informationAntiplatelet 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 informationVenous 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 informationDOACs. 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 informationAnalyzing 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 information48 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 informationDVT/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 information2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2.
Anticoagulation dosing at UCDMC (SC=subcutaneously; CI=continuous infusion) Indication Agent Dose Comments Prophylaxis Any or No bleeding risk factors see adult heparin (VTE prophylaxis) IV infusion order
More informationThe 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 informationGuideline 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 informationAnticoagulation Dosing at UCDMC Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h
Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h See EMR adult VTE prophylaxis CI order set Enoxaparin See service specific dosing Assess
More informationFDA 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 informationTSOAC 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 informationHow To Compare The 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 informationUse of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia
Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Insertion, removal or presence of a catheter in selected sites can place a patient who is antithrombotic agent at risk for a local bleeding
More informationDabigatran (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 informationThe 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 informationNew 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 informationNovel 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 informationTraditional 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 informationNew 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 informationAnticoagulation and Reversal
Anticoagulation and Reversal John Howard, PharmD, BCPS Clinical Pharmacist Internal Medicine Affiliate Associate Clinical Professor South Carolina College of Pharmacy Disclosures I have no Financial, Industry,
More informationAnticoagulation 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 informationHow To Treat Aneuricaagulation
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 informationManagement 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 informationDual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute
Dual Antiplatelet Therapy Stephen Monroe, MD FACC Chattanooga Heart Institute Scope of Talk Identify the antiplatelet drugs and their mechanisms of action Review dual antiplatelet therapy in: The medical
More informationThrombosis 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 informationEast Kent Prescribing Group
East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal
More informationSpeaker 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 informationObjectives. 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 informationFailure 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 informationAnticoagulation 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 informationBreadth 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 informationComparison between New Oral Anticoagulants and Warfarin
Comparison between New Oral Anticoagulants and Warfarin Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. In recent years, several
More information1/12/2016. 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 informationThe 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 informationCardiology Medications New Drugs, New Guidelines
Cardiology Medications New Drugs, New Guidelines Ken Kester, PharmD, JD Pharmacy Team Leader Nebraska Heart Hospital August 4, 2014 Cardiology Medications Objectives The attendee will understand Indications,
More informationNovel 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 informationABOUT XARELTO CLINICAL STUDIES
ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the
More informationGetting smart about dyspnea and life saving drug therapy in ACS patients. Kobi George Kaplan Medical Center Rehovot
Getting smart about dyspnea and life saving drug therapy in ACS patients Kobi George Kaplan Medical Center Rehovot 78 year old female Case description Presented with resting chest pain and dyspnea Co morbidities:
More information3/3/2015. 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 informationBridging 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 informationNew 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 informationNone. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015
Financial Disclosure Information Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Dual Antiplatelet
More informationComparative Anticoagulation
Comparative Anticoagulation Laurajo Ryan, PharmD, MSc, BCPS, CDE Clinical Associate Professor The University of Texas at Austin College of Pharmacy The University of Texas Health Science Center Pharmacotherapy
More informationXabans 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 informationNew 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 informationAHA/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 informationEfficacy 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 informationNew Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis
New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET Departments of Gastroenterology and Hepatology,
More informationNew Anticoagulants: What to Use What to Avoid
New Anticoagulants: What to Use What to Avoid Bruce Davidson, MD, MPH Clinical Professor of Medicine Pulmonary and Critical Care Medicine Division University of Washington School of Medicine Seattle USA
More informationAnticoagulation: Recent Changes and Pros and Cons of Current Therapies
Anticoagulation: Recent Changes and Pros and Cons of Current Therapies Fadi Shamoun, MD, FACC, FASE, FSVM Mayo Clinic in Arizona 2015 MFMER slide-1 How Many Prescribe? A. Dabigatran? B. Rivaroxaban? C.
More informationApixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial
Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,
More informationCardiology Medications New Drugs, New Guidelines
Cardiology Medications New Drugs, New Guidelines Ken Kester, PharmD, JD Pharmacy Team Leader Nebraska Heart Hospital August 4, 2014 CARDIOLOGY MEDICATIONS Objectives The attendee will understand Indications,
More informationWarfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab
Warfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 28, 2015 2:30 pm I have no disclosures. Stroke risk reduction in
More informationNew Oral Anticoagulants (NOACs)
New Oral Anticoagulants (NOACs) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Apixaban (Eliquis) Edoxaban (Savaysa) Janice Lawson, MD Tallahassee Memorial Hospital Cancer and Hematology Specialists Disclosure
More informationNovel 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 informationStepping Beyond Warfarin:
Stepping Beyond Warfarin: Working with Novel Oral Anticoagulants (NOACs) in Clinical Practice USAFP 2015 CPT Tyler R Reese, MD US Army, Medical Corps Tripler Army Medical Center Disclosures: Neither I,
More informationAntiplatelet 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 informationAnticoagulation: 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 informationSTROKE 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 informationTHE BENEFITS OF RIVAROXABAN (XARELTO ) ACROSS MULTIPLE INDICATIONS AND THE RELEVANCE TO CARDIOLOGISTS
THE BENEFITS OF RIVAROXABAN (XARELTO ) ACROSS MULTIPLE INDICATIONS AND THE RELEVANCE TO CARDIOLOGISTS Ingo Ahrens, Christoph Bode Cardiology and Angiology I, Heart Center Freiburg University, Freiburg,
More informationReversing the New Anticoagulants
Reversing the New Anticoagulants Disclosure Susan C. Lambe, MD Assistant Clinical Professor Department of Emergency Medicine University of California, San Francisco Roadmap for today 1 Roadmap for today
More informationDABIGATRAN ETEXILATE TARGET Vitamin K epoxide reductase WARFARIN RIVAROXABAN APIXABAN
TARGET SPECIFIC ORAL ANTICOAGULANTS (TSOACs) This document is intended as a guideline only and should not replace sound clinical judgment Please refer to UNMH formulary in Lexicomp for approved use(s)
More informationNew Oral Anticoagulant (Rivaroxaban [Xarelto])
TABLE OF CONTENTS New Oral Anticoagulant (Rivaroxaban [Xarelto]) 1-2 New Antiplatelet (Ticagrelor [Brilinta]) 2-3 Update on Dabigatran (Pradaxa) Safety and Use at UIMCC 3-4 What Methods are Available for
More informationRivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012
Rivaroxaban A new oral anti-thrombotic Dr. Hisham Aboul-Enein Professor of Cardiology Benha University 12/1/2012 Agenda Ideal anticoagulant. Drawbacks of warfarin. Rivaroxaban in clinical trails. Present
More informationSTARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach
STARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach Jeffrey I Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis
More informationNew Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther
New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis Mark Crowther 1 Disclosures Advisory Boards in last 24 months Pfizer, Alexion, Bayer, CSL Behring,
More informationThree new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
More informationNew Anticoagulants: When and Why Should I Use Them? Disclosures
Winship Cancer Institute of Emory University New Anticoagulants: When and Why Should I Use Them? Christine L. Kempton, MD, MSc Associate Professor of Pediatrics and Hematology and Medical Oncology Hemophilia
More informationL'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy ISO 9001
L'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy Scientific Advances and Cardiovascular Mortality Nabel and
More information1/7/2012. 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 informationOptimizing 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 informationAnticoagulants 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 informationClinical Use of Rivaroxaban: Pharmacokinetic and Pharmacodynamic Rationale for Dosing Regimens in Different Indications
Drugs (2014) 74:1587 1603 DOI 10.1007/s40265-014-0278-5 REVIEW ARTICLE Clinical Use of Rivaroxaban: Pharmacokinetic and Pharmacodynamic Rationale for Dosing Regimens in Different Indications Toby Trujillo
More informationNew Drugs for the Primary Care Provider: What You Need to Know
Presenter Disclosure Information 11:05 11:45am New Drugs for PCP: What You Need to Know SPEAKER Gerald Smetana, MD The following relationships exist related to this presentation: Gerald W. Smetana, MD:
More informationNew 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 informationNew 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 informationAnticoagulation 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 informationWOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION. Van Crisco, MD, FACC, FSCAI First Coast
WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION Van Crisco, MD, FACC, FSCAI First Coast Conflicts of Interest I have been a paid consultant and speaker for AstraZeneca, makers of
More informationThrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare
Thrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare Kenya Association of Physicians Conference 10 th May 2013 New anticoagulants:
More informationGoals 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 informationNon- 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 informationLong 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 informationRivaroxaban for acute coronary syndromes
Northern Treatment Advisory Group Rivaroxaban for acute coronary syndromes Lead author: Nancy Kane Regional Drug & Therapeutics Centre (Newcastle) May 2014 2014 Summary Current long-term management following
More informationNEWER 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 informationThe Brave New (Anticoagulant) World
The Brave New (Anticoagulant) World Diane M. Birnbaumer, M.D., FACEP Emeritus Professor of Medicine University of California, Los Angeles Senior Clinical Educator Department of Emergency Medicine Harbor-UCLA
More informationAnticoagulants. Denver Health April 12, 2011
New Oral Anticoagulants Rebecca Hanratty, MD Denver Health April 12, 2011 Overview Why we need alternatives to warfarin Review of the 3 new oral anticoagulants Results from major trials: Thromboprophylaxis
More informationHow To Understand The History Of Analgesic Drugs
New Developments in Oral Anticoagulants: Treating and Preventing Embolic Events in the 21 st Century David Stewart, PharmD, BCPS Associate Professor of Pharmacy Practice East Tennessee State University
More informationDisclosure/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 informationDuration of Dual Antiplatelet Therapy After Coronary Stenting
Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are
More informationCommittee Approval Date: September 12, 2014 Next Review Date: September 2015
Medication Policy Manual Policy No: dru361 Topic: Pradaxa, dabigatran Date of Origin: September 12, 2014 Committee Approval Date: September 12, 2014 Next Review Date: September 2015 Effective Date: November
More informationMore information for patients and caregivers can be accessed at http://www.xarelto-us.com/.
Janssen Research & Development Submits Application to U.S. FDA for XARELTO (rivaroxaban) to Reduce Secondary Cardiovascular Events in Patients with Acute Coronary Syndrome RARITAN, DECEMBER 29, 2011 -
More informationNew 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 informationXarelto (Rivaroxaban): Effective in a broad spectrum. Joep Hufman, MD Medical Scientific Liason
Xarelto (Rivaroxaban): Effective in a broad spectrum Joep Hufman, MD Medical Scientific Liason Xarelto : Effective in a broad spectrum Introduction Therapeutic areas SPAF VTE Prevention VTE treatment Practical
More informationMaking Sense of the Newer Anticoagulants
Making Sense of the Newer Anticoagulants Brian Tiffany, MD, PhD, FACEP Dept of Emergency Medicine Chandler Regional Medical Center Mercy Gilbert Medical Center I M FROM ARIZONA! DISCLOSURES No relevant
More information