Laboratory Detection of Newer Anticoagulant Drugs
|
|
- Stuart Fleming
- 8 years ago
- Views:
Transcription
1 Laboratory Detection of Newer Anticoagulant Drugs Dorothy M. (Adcock) Funk, M.D. Colorado Coagulation, Laboratory Corporation of America Holdings Outline Newer Oral Anticoagulant Therapies A brief introduction - direct thrombin inhibitors (DTI) and direct Xa inhibitors (DXa) Laboratory detection to determine measured drug concentration Drug calibrated assays Laboratory detection to determine relative drug concentration Routine coagulation assays Effect on specialty coagulation assays Direct Oral Anticoagulant Agents (DOACs) or Target-Specific Oral Anticoagulants (TSOACs) Direct Thrombin Inhibitors Dabigatran Ximelagatran Direct Xa Inhibitors Rivaroxaban Apixaban Edoxaban Predictable pharmacodynamic and pharmacokinetic responses with little dietary effect Do not require therapeutic monitoring Dose is not adjusted based on laboratory measures Pharmaceutical manufacturers do not provide Therapeutic Ranges No published studies correlating plasma drug levels with thrombotic or hemorrhagic complications Dabigatran ng/ml Rivaroxaban ng/ml Trough Peak Trough Peak %* ** Published # Ranges are based on mass spectrometry n = mg dabigatran bid n = 29 2 mg rivaroxaban qd **Francart S, Hawes E, Deal A, et al. Thromb Haemost 214 doi /TH *Van Ryn J, Stangier J, Haertter S, et al. Thromb Haemost 21;13: Mueck W, Borris LC, Dahl OE, et al. Thromb Haemost 28;1: Although monitoring is not required, there are situations where it may be important to gauge drug level: Patients requiring emergent surgery Patients suffering potential overdose Patients with significant renal failure Patients with hemorrhagic or thrombotic complications Assessing efficacy of reversal strategies in patients with major bleeding 1
2 Laboratory Detection of DTIs and DXa Inhibitors International Society on Thrombosis and Haemostasis (ISTH) Scientific and Standardization Committee (SSC); Subcommittee on the Control of Anticoagulation, April 213 recommendation: Two types of assays should be considered #1) Assay that provides quantitative results to determine concentration of drug in serum or plasma. #2) Readily available, easily performed assay that can be used in an urgent clinical scenario to provide semiquantitative results, e.g. supratherapeutic, therapeutic or sub therapeutic anticoagulation. This assay is not to be used to determine drug concentration Baglin T, Hillarp A, Tripodi A, et al, J Thromb Haemost 213;11: Coagulation Cascade: In vitro model DXa FXII FXI FIX APTT FVIII Intrinsic pathway FV FII FXa Fibrinogen FVII PT Extrinsic pathway Thrombin FIIa TCT ECA Fibrin DTI Drug-specific assays Use a calibration curve specific for drug being measured Can be based on a variety of assays DTI: Dilute Thrombin Time (Aniara HEMOCLOT Thrombin Inhibitors), Ecarin Chromogenic Assay (Diagnostica Stago) Direct FXa: Chromogenic Anti-Xa Assay, PT Both: TFC-LC-MS/MS, Generally perform well over the on-therapy range of the drug Research or Investigational Use Only Hemoclot Thrombin Inhibitors* Aniara (HYPHEN BioMed) Quantitative measure of DTIs A modified thrombin time method Diluted test plasma is mixed with normal pooled plasma; clotting initiated by addition of a constant amount of alpha thrombin and clotting time is directly proportional to [DTI] The assay is calibrated with the specific DTI Insensitive to: Levels of coagulation factors VKA Lupus anticoagulant *RUO Assay Ecarin Chromogenic Assay* Diagnostica Stago, Inc 3 Total, Unconjugated 4. Dabigatran by LC- MS/MS Prothrombin (excess) Ecarin Meizothrombin Chromogenic Substrate X DTI pna (45)nm OD of pna is inversely proportional to [DTI] in plasma The assay is calibrated with the specific DTI Time, min Insensitive to: LLOQ (5ng/mL) 3.2e5 Levels of coagulation factors VKA Lupus anticoagulant *RUO Assay 15 Blank Defib Human Plasma e Time, min Time, min ULOQ (5ng/mL) Analyte Area / IS Area 2. "Linear" Regression ("1 / x" weighting): y =.79 x +.27 (r =.9999) Analyte Conc. / IS Conc. The assay is calibrated with the specific DTI Intra-Assay Characteristics Replicate LLOQ QC1 QC2 QC3 ULOQ Mean Std Dev Imprecision (%) Inaccuracy (%) NA NA NA
3 Anti-Xa Assays for DXa Inhibitors Anti-Xa Assay Principal Patient sample (DXa) + FXa (in excess) Residual Xa = [1/DXa] Measured with a chromogenic substrate The assay is calibrated with the specific DXa (rivaroxaban) Two different kit manufacturers were evaluated Kits supplemented with anti- Thrombin are not recommended Apixaban Treated Patients n Apixaban was administered at 5 or 1 mg bid or 2 mg qd in patients with acute VTE n Strong, linear correlation between plasma drug concentration and anti-xa activity Calibrated with apixaban Calibrated with LMWH Francart S, Hawes E, Deal A, et al. Thromb Haemost 214 doi /TH * Barrett YC. Thromb Haemost 21;14: Chromogenic Anti-Xa Assays and Direct FXa Inhibitor Drugs Using LMWH/UFH Calibrators Direct FXa inhibitor drug will be detected regardless of assay calibrator used Strong correlation with UFH and LMWH calibration curves but detection limits are too narrow. Gosselin R,Moll S, Adcock D. Unpublished Will read below detection limit when up to 3mg/mL drug is present. At peak, levels often above the highest calibrator On therapy range may extend to 3 5 IU/mL or higher Laboratory Detection of DTIs/DXa Inhibitors: Routine Assays APTT, PT and thrombin time: Responsiveness of different reagents varies significantly Tend to be too insensitive, too sensitive, or fail to show the appropriate dose response General rules: APTT more responsive to dabigatran than PT A normal APTT does not exclude on-therapy levels of dabigatran* PT more responsive to direct FXa inhibitors than APTT A normal PT does not exclude on-therapy levels of rivaroxaban** TT is exquisitely responsive to dabigatran A normal TT indicates that minimal or no dabigatran is present TT shows no response to direct Xa inhibitors **Francart S, Hawes E, Deal A, et al. Thromb Haemost 214 doi /TH Dabigatran Effect on APTT and PT Dabigatran TT Response 3 25 Thrombin Time (s) On therapy range *Hawes E, Deal A, Jeanneret, et al. J Thromb Haemost. Upper limit of normal range Dabigatran measured by LC- MS/MS ng/ml 3
4 Rivaroxaban Effect on APTT and PT On therapy range Upper limit norma lrange Laboratory Detection - DTI ISTH SCC Recommendations for Dabigatran Activated Partial Thromboplastin Time (APTT) Can be used to determine relative intensity of anticoagulation 15 mg twice daily, peak APTT is approximately 2X control Anticoagulant effect may be underestimated by the APTT when levels are supratherapeutic Each laboratory should be aware of the sensitivity of their reagent, and this can be done using commercially available controls or calibrators Prothrombin Time Relatively insensitive to dabigatran Thrombin Time (TT) A normal TT indicates that minimal or no dabigatran is present Francart S, Hawes E, Deal A, et al. Thromb Haemost 214 doi /TH Laboratory Detection - DXa ISTH SCC Recommendations for Rivaroxaban Activated Partial Thromboplastin Time (APTT) Some reagents are very insensitive, no prolongation is seen even at peak levels Prothrombin Time (PT) Can be used to determine relative intensity of anticoagulation Each laboratory should be aware of the sensitivity of their reagent, this can be done using commercially available controls or calibrators Samama MM, et al. Thromb Haemost. 21;13: Amount of rivaroxaban needed to double the PT varied from 66ng/mL to 7ng/mL depending on the reagent, with no correlation to ISI Baseli CAL PAT 2CT CAL PAT ne 2CT Dabigatra 2CT 2CT NPP Dabigatra n Rivaroxa Rivaroxa (s) n (ng/ml) ban (ng/ ban (ng/ml) ml) (ng/ml) PT Innovin Neoplastin CI APTT SynthASil PTT-A Drug concentration based on patient sample determined by MS versus drug concentration based on calibrator Gosselin R,Moll S, Adcock D. Unpublished Effect of Dabigatran on Factor Assays Factor Activity in IU/dL FVIII FIX FXI Intrinsic Factors APTT-Based The mechanism of action of direct and indirect FXa inhibitors is significantly different as direct FXa inhibitors can inhibit Xa in the prothrombinase complex which is 3, fold more efficient in converting prothrombin to thrombin than free Xa. Does a 24s PT in a patient on warfarin equate to the same level of anticoagulation when a patient has a 24s PT on rivaroxaban? Haas, S. Thromb Haemost 21; 13: Extrinsic Factors PT-Based * Adcock DM, et al. AJCP. 213;139:
5 Dabigatran and Rivaroxaban Effect on Coagulation Assays % change compared to Reference Plasma FII FV FX FVIII FIX FXI AT PC PS AT assays either IIa Laboratory Xa based PC and PS assays: clot-based APCR * Adcock DM, et al. AJCP. 213;139:12-19; ECAT Proficiency Data 212. Dabigatran Rivaroxaban Dabigatran and Rivaroxaban Effect on Coagulation Assays Drugs act as inhibitors: Incomplete correction with 1:1 plasma mix Can cause a false positive Bethesda assay False positive Lupus Anticoagulant Assays No effect on: D-dimer, VWF assays, free protein S antigen, chromogenic protein C activity, reptilase time Thank you Dot.Adcock@esoterix.com
Consultative Coagulation How to Effectively Answer Common Questions About Hemostasis Testing Session #5020
Consultative Coagulation How to Effectively Answer Common Questions About Hemostasis Testing Session #5020 Dorothy M. (Adcock) Funk, M.D. Colorado Coagulation Karen A. Moser, M.D. Saint Louis University
More informationNew anticoagulants: Monitoring or not Monitoring? Not Monitoring
The 2 nd World Congress on CONTROVERSIES IN HEMATOLOGY (COHEM) Barcelona, Spain September 6 8, 2012 New anticoagulants: Monitoring or not Monitoring? Not Monitoring Anna Falanga, MD Immunohematology and
More informationThe laboratory and new anticoagulant drugs
The laboratory and new anticoagulant drugs Andreas Hillarp Department of Clinical Chemistry and Transfusion Medicine Halland County Hospital, Sweden andreas.hillarp@regionhalland.se Disclosures for Andreas
More informationNew Oral Anticoagulants
Laboratory Monitoring of New Oral Anticoagulants.....What you need to know Rita Selby MD Medical Director, Coagulation Laboratories Uniersity Health Network & Sunnybrook HSC Uniersity of Toronto The 15
More informationLaboratory Testing in Patients on Novel Oral Anticoagulants (NOACs)
Laboratory Testing in Patients on Novel Oral Anticoagulants (NOACs) Dr. Art Szkotak artur.szkotak@albertahealthservices.ca University of Alberta Hospital Edmonton, AB NOACs Direct Thrombin Inhibitors (DTI):
More informationMonitoring of new oral anticoagulants
Monitoring of new oral anticoagulants Jonathan Douxfils, Bernard Chatelain September 27th, 2012 1 Content Introduction Monitoring of NOACs Why? Dabigatran etexilate PD properties PK properties Rivaroxaban
More informationUSE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN)
USE AND INTERPRETATION OF LABORATORY COAGULATION TESTS IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals:
More informationThe management of cerebral hemorrhagic complications during anticoagulant therapy
The management of cerebral hemorrhagic complications during anticoagulant therapy Maurizio Paciaroni Stroke Unit Division of Cardiovascular Medicine University of Perugia - Italy Perugia Stroke Registry
More informationSession 3 Topics. Argatroban. Argatroban. Drug Use and Adverse Effects. Laboratory Monitoring of Anticoagulant Therapy
~~Marshfield Labs Presents~~ Laboratory Monitoring of Anticoagulant Therapy Session 3 of 4 Michael J. Sanfelippo, M.S. Technical Director, Coagulation Services Session 3 Topics Direct Thrombin Inhibitors:
More informationPost-ISTH review: Thrombosis-I New Oral Anticoagulants 臺 大 醫 院 內 科 部 血 液 科 周 聖 傑 醫 師
Post-ISTH review: Thrombosis-I New Oral Anticoagulants 臺 大 醫 院 內 科 部 血 液 科 周 聖 傑 醫 師 The antithrombotic efficacy is limited but the risk of bleeding is indefinite Fuster V et al. Circulation 2011;123:e269-e367
More informationBiomarkers for new anticoagulants vice and virtue
Biomarkers for new anticoagulants vice and virtue Dagmar Kubitza, MD AGAH, München 2014 Page 1 Definition of Biomarkers?. Surrogate markers are primary measures the effectiveness of investigational drugs.
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 informationLupus anticoagulant Pocket card
Lupus anticoagulant Pocket card Issue number 5 2012 Antiphospholipid Syndrome 1 The antiphospholipid syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and /or pregnancy loss
More informationDe effecten van Cofact op Rivaroxaban plasma in trombine generatie assays
De effecten van Cofact op Rivaroxaban plasma in trombine generatie assays In vitro assessment, using thrombin generation, of the applicability of Prothrombin Complex Concentrate as an antidote for Rivaroxaban
More informationInfluence of New Anticoagulants on Coagulation Tests
Influence of New Anticoagulants on Coagulation Tests White Paper Helen Mani, PhD; Carola Wagner, PhD; Professor Edelgard Lindhoff-Last, MD Answers for life. Influence of New Anticoagulants on Coagulation
More informationTitle of Guideline. Thrombosis Pharmacist)
Title of Guideline Contact Name and Job Title (author) Guideline for patients receiving Rivaroxaban (Xarelto ) requiring Emergency Surgery or treatment for Haemorrhage Julian Holmes (Haemostasis and Thrombosis
More informationNew Oral Anticoagulant Drugs What monitoring if any is required?
New Oral Anticoagulant Drugs What monitoring if any is required? Michelle Williamson Supervising Scientist High Throughput Haematology Pathology Queensland PAH Laboratory Overview Background What new oral
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 informationComparison of Anti-Xa and Dilute Russell Viper Venom Time Assays in Quantifying Drug Levels in Patients on Therapeutic Doses of Rivaroxaban
Comparison of Anti-Xa and Dilute Russell Viper Venom Time Assays in Quantifying Drug Levels in Patients on Therapeutic Doses of Rivaroxaban Robert C. Gosselin, CLS; Dorothy M. (Adcock) Funk, MD; J. Michael
More informationAnalytical Specifications RIVAROXABAN
Page 1 of 9 ANALYTE NAME AND STRUCTURE - RIVAROXABAN SYNONYMS Xarelto CATEGORY Anticoagulant TEST CODE PURPOSE Therapeutic Drug Monitoring GENERAL RELEVANCY BACKGROUND Xarelto (rivaroxaban) is an orally
More 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 informationImpact of new (direct) oral anticoagulants in patient blood management
Impact of new (direct) oral anticoagulants in patient blood management Yulia Lin, MD, FRCPC, CTBS Transfusion Medicine & Hematology, Sunnybrook Health Sciences Centre Dept of Laboratory Medicine & Pathobiology,
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 informationMANAGING BLEEDING IN THE
MANAGING BLEEDING IN THE SETTING OF NEW ANTICOAGULANTS: HOW DO OLD METHODS MEASURE UP? Michelle Zeller MD Clinical Hematology Fellow November 5th, 2011 A FRIDAY NIGHT ON-CALL WITH DR. B. LUD Very keen
More informationThe Laboratory and the New Oral Anticoagulants
Papers in Press. Published October 5, 2012 as doi:10.1373/clinchem.2012.189704 The latest version is at http://hwmaint.clinchem.org/cgi/doi/10.1373/clinchem.2012.189704 Clinical Chemistry 59:2 000 000
More information5/21/2012. Perioperative Use Issues. On admission: During hospitalization:
Dabigatran and Rivaroxaban: Challenges in the Perioperative Setting Claudia Swenson, Pharm.D., CDE, BC-ADM, FASHP Central Washington Hospital Wenatchee, WA claudia.swenson@cwhs.com Dabigatran and Rivaroxaban:
More informationThe Anticoagulated Patient A Hematologist s Perspective
The Anticoagulated Patient A Hematologist s Perspective Deborah M. Siegal MD MSc FRCPC Clinical Scholar Division of Hematology and Thromboembolism Thrombosis Canada Research Fellow McMaster University
More informationAnticoagulation Essentials! Parenteral and Oral!
Anticoagulation Essentials! Parenteral and Oral! Anti-Xa and Anti-IIa! Parenteral Anticoagulants! Heparin family (indirect anti-xa and anti-iia):! UFH! LMWH (enoxaparin, fondaparinux)! Direct thrombin
More informationNow We Got Bad Blood: New Anticoagulant Reversal
Now We Got Bad Blood: New Anticoagulant Reversal Kellie Rodriguez, PharmD, BCPS PGY2 Emergency Medicine Pharmacy Resident UF Health Jacksonville January 2016 Objectives 1. Review current treatment strategies
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 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 informationDisclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU
New Agents for Treatment of DVT Disclosure PI Adopt and Amplify trials Mark Oliver, MD, RVT, RPVI,FSVU BMS and Pfizer Speaker VTE Venous Thromboembolism Recognized DVT s New : 170,000 Recurrent : 90,000
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 informationNEW ORAL. François Mullier, Jonathan Douxfils, Anne Spinewine, Bernard Chatelain, Christian Chatelain, Jean-Michel Dogné. CORATA June 9 th, 2011
NEW ORAL ANTICOAGULANTS François Mullier, Jonathan Douxfils, Anne Spinewine, Bernard Chatelain, Christian Chatelain, Jean-Michel Dogné CORATA June 9 th, 2011 Content Introduction - Overview of blood coagulation
More information4/6/2015. Agenda. VTE by the Numbers VTE. Pulmonary Embolism (PE)
Generate Knowledge Agenda Anticoagulation Past and Present 2015 CLCC Meeting Denver, Colorado VTE Review of basic coagulation PT/INR and coumadin therapy Heparin monitoring past and present New anticoagulants
More informationThe new oral anticoagulants & the future of haemostasis laboratory testing. Alcohol: the good, the bad and the ugly
The new oral anticoagulants & the future of haemostasis laboratory testing Emmanuel J Favaloro Diagnostic Haemostasis Laboratory, Institute of Clinical Pathology & Medical Research, ICPMR, Pathology West,
More informationWolfgang Mueck *, Stephan Schwers and Jan Stampfuss
Mueck et al. Thrombosis Journal 2013, 11:10 REVIEW Open Access Rivaroxaban and other novel oral anticoagulants: pharmacokinetics in healthy subjects, specific patient populations and relevance of coagulation
More informationReversal of Old and New Antithrombotic Drugs. Mike Makris
Reversal of Old and New Antithrombotic Drugs Mike Makris BCSH guidelines Guidelines on oral anticoagulation with warfarin fourth edition 1 Guideline on the urgent or emergency reversal of antithrombotic
More informationClinical application of Thrombin Generation for new oral anticoagulants
Clinical application of Thrombin Generation for new oral anticoagulants François Mullier, Jonathan Douxfils, Christian Chatelain, Bernard Chatelain, Jean-Michel Dogné August 2012, 29th 1 1 Background (I)
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 informationDr Gordon Royle Haematologist, Middlemore Hospital
The New Oral Anticoagulants (NOACs) Dr Gordon Royle Haematologist, Middlemore Hospital Disclaimers Boehringer-Ingelheim Bayer Sanofi Douglas Pharmaceuticals Preventing disasters: lessons learned A cautionary
More informationAre there sufficient indications for switching to new anticoagulant agents
Are there sufficient indications for switching to new anticoagulant agents Meyer Michel Samama et Gregoris Gerotziafas Groupe Hémostase-Thrombose Hôtel-Dieu, Hôpital Tenon, Paris & Biomnis Ivry/seine,
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 informationDisclosure. Warfarin
Disclosure No conflicts of interest to disclose Reversal Strategies for Novel Oral Anticoagulants Noelle de Leon, PharmD, BCPS Critical Care Pharmacist, Department of Pharmaceutical Services Assistant
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 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 informationDr Gordon Royle Haematologist, Middlemore Hospital
The New Oral Anticoagulants (NOACs) Dr Gordon Royle Haematologist, Middlemore Hospital Disclaimers Boehringer-Ingelheim Bayer Sanofi Douglas Pharmaceuticals Preventing disasters: lessons learned A cautionary
More informationORIGINAL PAPERS. Effects of Rivaroxaban Therapy on ROTEM Coagulation Parameters in Patients with Venous Thromboembolism**
ORIGINAL PAPERS Adv Clin Exp Med 2015, 24, 6, 995 1000 DOI: 10.17219/acem/42147 Copyright by Wroclaw Medical University ISSN 1899 5276 Krzysztof Chojnowski*, A, C F, Tomasz Górski*, A F, Marta Robak B,
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 informationNHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS
NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS Date of First Issue 01/12/ 2012 Approved 15/11/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016
More information2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS
ANTICOAGULATION UPDATE C AR R I E P AL M E R, D N P, RN, AN P - BC OBJECTIVES At the end of the presentation, the NP will be able to: Identify new indications for target-specific oral anticoagulants (TSOACs),
More 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 informationAssays for Measuring Rivaroxaban: Their Suitability and Limitations
REVIEW ARTICLE Assays for Measuring Rivaroxaban: Their Suitability and Limitations Edelgard Lindhoff-Last, MD,* Meyer Michel Samama, MD, Thomas L. Ortel, MD, Jeffrey I. Weitz, MD, k and Theodore E. Spiro,
More informationDabigatran - Rivaroxaban: Variability and monitoring
Dabigatran - Rivaroxaban: Variability and monitoring Jean-Michel Dogné, Jonathan Douxfils, François Mullier, Christian Chatelain, Bernard Chatelain, December 1 st, 2011 1 Anticoagulant landscape 2 Commonly
More informationEx vivo effects of low-dose rivaroxaban on specific coagulation assays and coagulation factor activities in patients under real life conditions
New Technologies, Diagnostic Tools and Drugs 127 Ex vivo effects of low-dose rivaroxaban on specific coagulation assays and coagulation factor activities in patients under real life conditions Helen Mani;
More informationDISCLOSURES CONFLICT CATEGORY. No conflict of interest to disclose
DISCLOSURES CATEGORY Employment Research support Scientific advisory board Consultancy Speakers bureau Major stockholder Patents Honoraria Travel support Other CONFLICT No conflict of interest to disclose
More informationAnticoagulant Treatment for Deep Venous Thrombosis Direct Oral Anticoagulants (NOACs)
Anticoagulant Treatment for Deep Venous Thrombosis Direct Oral Anticoagulants (NOACs) Prof. P. HAINAUT Médecine Interne - Maladie Thromboembolique Cliniques Univ. Saint Luc - UCL Background Direct Oral
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 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 informationNew oral anticoagulants and haemorrhage
New oral anticoagulants and haemorrhage Dr Tina Biss Consultant Haematologist Newcastle Hospitals NHS Trust Too much to lose Durham Conference Centre 14 th November 2012 Disclosures/Conflicts of interest
More informationNON-VITAMIN K ORAL ANTICOAGULANT REVERSAL
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationNON-VITAMIN K ORAL ANTICOAGULANT REVERSAL
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More 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 informationPRACTICAL MANAGEMENT OF ANTICOAGULATION
PRACTICAL MANAGEMENT OF ANTICOAGULATION THE BLOOD THINS AND THE PLOT THICKENS Juliann Horne, PharmD PGY2 Pharmacy Resident in Ambulatory Care UNM College of Pharmacy jmhorne@salud.unm.edu Disclosure No
More informationHemostasis and Thrombosis Update for Primary Care Providers. Primary Care Medicine: Principles and Practice. Topic Outline
Hemostasis and Thrombosis Update for Primary Care Providers Primary Care Medicine: Principles and Practice Topic Outline Non-Vitamin K antagonist Oral Anti-Coagulants NOACs Background on these agents Use
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 informationDevang 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 informationMCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants
MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013 Anticoagulants Anticoagulants are agents that prevent the formation of blood clots. Before we can talk about
More informationClinical Guideline N/A. November 2013
State if the document is a Trust Policy/Procedure or a Clinical Guideline Clinical Guideline Document Title: Document Number 352 Version Number 1 Name and date and version number of previous document (if
More informationApplication Sheet for Rivaroxaban (Xarelto ) Standard Range with. BIOPHEN Heparin LRT (#221011/221013) RUO
Instrument Adaptation The attached instrument adaptation has been prepared and validated by the reagent manufacturer, Hyphen-Biomed. Instrument Siemens BCS-XP Product BIOPHEN Heparin LRT Analyte Rivaroxaban
More informationCoagulation issues and bridging. Joost van Veen Consultant Haematologist - STHFT
Coagulation issues and bridging Joost van Veen Consultant Haematologist - STHFT new oral anticoagulants NOAC New oral anticoagulants NOAC Novel oral anticoagulants NOAC Non vitamin K oral anticoagulants
More informationNOVEL ANTICOAGULANTS
NOVEL ANTICOAGULANTS MAKING EDUCATED GUESSES IN PATIENTS WITH ACUTE ISCHEMIC STROKE IGOR RYBINNIK, M.D. Assistant Professor of Neurology Rutgers Robert Wood Johnson Medical School DISCLOSURES FINANCIAL
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 informationWhat to do in case of hemorragia. L Camoin Jau Service d Hématologie APHM Marseille
What to do in case of hemorragia with NOAC? L Camoin Jau Service d Hématologie APHM Marseille Disclosure Boehringer Bayer Daishi Sanofi BMS Pharmacodynamic and kinetic properties of new oral anticoagulants.
More informationNnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl
NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl Mikele Wissing, RN June 2014 Introduction until recently, was the unrivaled medication for treatment
More informationReversal of Anticoagulants at UCDMC
Reversal of Anticoagulants at UCDMC Introduction: Bleeding complications are a common concern with the use of anticoagulant agents. In selected situations, reversing or neutralizing the effects of an anticoagulant
More informationWarfarin and Rivaroxaban Duplication: A Case Report and Medication Error Analysis
Drug Saf - Case Rep (2015) 2:5 DOI 10.1007/s40800-015-0007-3 CASE REPORT Warfarin and Rivaroxaban Duplication: A Case Report and Medication Error Analysis Julie A. Fusco 1 Eric J. Paulus 2 Alexandra R.
More informationCritical Bleeding Reversal Protocol
Critical Bleeding Reversal Protocol Coagulopathy, either drug related or multifactorial, is a major contributing factor to bleeding related mortality in a variety of clinical settings. Standard therapy
More 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 informationAntithromboticthrombotic Monitoring
Introduction to Antithromboticthrombotic Monitoring 1 Topics What is thrombosis, and why is it significant? Coagulation Cascade Pathways of coagulation, anticoagulation, and fibrinolysis Thrombophilia
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 information4/9/2015. 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 informationLAMC Reversal Agent Guideline for Anticoagulants 2013. Time to resolution of hemostasis (hrs) Therapeutic Options
LAMC Reversal Agent Guideline for Anticoagulants 2013 Medication resolution of hemostasis (hrs) Intervention Administration Instructions Heparin 3-4 Protamine 1mg IV for every 100 units of heparin Slow
More informationComparison of calibrated chromogenic anti-xa assay and PT tests with LC-MS/MS for the therapeutic monitoring of patients treated with rivaroxaban
Blood Coagulation, Fibrinolysis and Cellular Haemostasis 1 Comparison of calibrated chromogenic anti-xa assay and PT tests with LC-MS/MS for the therapeutic monitoring of patients treated with rivaroxaban
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 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 informationThe 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era. CCRN State of the Heart 2012 June 2, 2012
The 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era CCRN State of the Heart 2012 June 2, 2012 Disclosures I have I have been involved in trials of new anticoagulants and have received
More 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 informationNo more rat poison? New oral anticoagulants and perioperative considerations
1 No more rat poison? New oral anticoagulants and perioperative considerations Jerrold H. Levy, MD, FAHA, FCCM Professor Department of Anesthesiology/Critical Care Duke University School of Medicine Durham,
More informationPractical guide dabigatran Guidance for use in particular situations
Practical guide dabigatran Guidance for use in particular situations Writing Committee Prof. Dr. Hein Heidbüchel, Universitaire Ziekenhuizen, Leuven. Prof. Dr. Vincent Thijs, Universitaire Ziekenhuizen,
More informationAdherence to NOACs. Disclosure. Patricia van den Bemt EAHP Hamburg 2015
Adherence to NOACs Patricia van den Bemt EAHP Hamburg 2015 Disclosure Unrestricted research grants from Glaxo-SmithKline Boehringer Ingelheim Daiichi Sankyo Bayer Pfizer For research on medication safety
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 informationTo assist clinicians in the management of minor, major, and/or life-threatening bleeding in patients receiving new oral anticoagulants (NOACs).
MANAGEMENT OF BLEEDING IN PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To assist clinicians
More informationStop the Bleeding: Management of Drug-induced Coagulopathy. Stacy A. Voils, PharmD, BCPS Critical Care Specialist, Neurosurgery
Stop the Bleeding: Management of Drug-induced Coagulopathy Stacy A. Voils, PharmD, BCPS Critical Care Specialist, Neurosurgery Objectives Discuss contemporary management of warfarin reversal in patients
More informationOral Anticoagulation and the Devil You Don't Know vs the Devil You Do: Safety of NOACs vs Warfarin
Oral Anticoagulation and the Devil You Don't Know vs the Devil You Do: Safety of NOACs vs Warfarin Charles V. Pollack, Jr., M.A., M.D., FACEP, FAAEM, FAHA, FCPP Professor and Chairman Department of Emergency
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 informationCOMPARISON 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 informationPosition Paper on Laboratory Testing for Patients Taking New Oral. Anticoagulants. Consensus Document of FCSA, SIMeL, SIBioC and
Position Paper on Laboratory Testing for Patients Taking New Oral Anticoagulants. Consensus Document of FCSA, SIMeL, SIBioC and CISMEL Armando Tripodi 1, Giancarlo Di Iorio 2, Giuseppe Lippi 3, Sophie
More informationOutline. Pearls and Pitfalls in the Hemostasis Laboratory. Disorder of Primary Hemostasis Platelet Defect or Von Willebrand Disease
Pearls and Pitfalls in the Hemostasis Laboratory Texas Society of Pathologists 93 rd Annual Meeting Dorothy M. (Adcock) Funk, MD Esoterix Coagulation January 18, 2014 Outline Pearls and Pitfalls: In the
More information