PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline
|
|
- Clarissa Richardson
- 3 years ago
- Views:
Transcription
1 PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline The aim of this document to guide clinicians on use of novel anticoagulants for stroke and TIA (transient ischaemic attack) prevention in patients with AF (atrial fibrillation) in Cornwall. 2. The Guidance Page 1 of 12
2 Peninsula Heart & Stroke Network Guidance Novel oral anticoagulants for the prevention of stroke and systemic embolism in atrial fibrillation PENINSULA HEART & STROKE NETWORK Purpose The purpose of this Network guidance is to inform prescribers and other healthcare professionals about the appropriate introduction of the novel oral anticoagulants (NOACs: dabigatran (Pradaxa ), rivaroxaban (arelto ) and apixaban (Eliquis )) as options for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation (AF). This is a new area of prescribing and this guidance sets out the main considerations and patient groups where these alternatives to warfarin may be useful. NICE Guidance for dabigatran and rivaroxaban has been worded almost identically, whilst keeping to the wording of their licences. NICE Guidance for apixaban was published in 2013, and the text is very similar. NICE Clinical Guideline 180 endorses new anticoagulants for use in non valvular AF (June 2014). Dabigatran: NICE Guidance ( 2012) Dabigatran etexilate is recommended as an option for the prevention of stroke and systemic embolism within its licensed indication, that is, in people with nonvalvular atrial fibrillation with one or more of the following risk factors: previous stroke, transient ischaemic attack or systemic embolism; left ventricular ejection fraction below 40%; symptomatic heart failure (NYHA Class 2 or more); age 75 or older; OR age 65 or older with one of the following: diabetes mellitus, coronary artery disease or hypertension. The decision about whether to start treatment with dabigatran should be made after an informed discussion between the clinician and the person about the risks and benefits of dabigatran compared with warfarin. For people who are taking warfarin, the potential risks and benefits of switching to dabigatran should be considered in the light of their level of INR control. Rivaroxaban: NICE Guidance ( 2012) Rivaroxaban is recommended as an option for preventing stroke and systemic embolism within its licensed indication, that is, in people with nonvalvular atrial fibrillation with one or more risk factors such as: congestive heart failure; hypertension; age 75 or older; diabetes mellitus; prior stroke or transient ischaemic attack The decision about whether to start treatment with rivaroxaban should be made after an informed discussion between the clinician and the person about the risks and benefits of rivaroxaban compared with warfarin. For people who are taking warfarin, the potential risks and benefits of switching to rivaroxaban should be considered in the light of their level of INR control. Apixaban: NICE Guidance ( 2013) Apixaban is recommended as an option for preventing stroke and systemic embolism within its marketing authorisation, that is, in people with nonvalvular atrial fibrillation with 1 or more risk factors such as: symptomatic heart failure; hypertension; age 75 or older; diabetes mellitus; prior stroke or transient ischaemic attack The decision about whether to start treatment with apixaban should be made after an informed discussion between the clinician and the person about the risks and benefits of apixaban compared with warfarin, dabigatran etexilate and rivaroxaban. For people who are taking warfarin, the potential risks and benefits of switching to apixaban should be considered in light of their level of INR control. Key considerations when choosing between the available oral anticoagulant options 1. Renal Function. Dabigatran is contraindicated in severe renal impairment (creatinine clearance [CrCl, or the surrogate of egfr] <30 ml/min), and a lower dose is used in moderate renal impairment and for patients aged over 80 (110 mg BD). Rivaroxaban is contraindicated in people with CrCl / egfr <15 ml/min, and the dose should be reduced to 15 mg OD for people with CrCl / egfr ml/min. Apixaban is contraindicated for people with CrCl / egfr <15 ml/min, and the dose should be reduced to Page 2 of 12
3 2.5 mg BD for people with CrCl / egfr ml/min, and for people aged 80 with serum creatinine >133 µmol/l or weight <60 kg. With all the NOACs drug accumulation can occur with impaired renal function. Renal function should be checked prior to initiation and monitored when necessary, such as when other drugs with renal effects are introduced or altered, or with dehydration/vomiting/diarrhoea. Renal function should be monitored at least annually in patients older than 75 years and in those with renal impairment. Liver function should be checked prior to initiating apixaban. As clinical experience accumulates, these monitoring requirements may be eased. 2. The efficacy and safety of the NOACs in people unable or unwilling (for whatever reason) to take warfarin, or in whom warfarin is relatively or absolutely contraindicated, has not been conclusively established. All patients in the principal published studies (n = 50,000) were eligible to be randomized to warfarin. In a comparison of apixaban with aspirin in 5599 patients considered for a variety of reasons to be unsuitable for warfarin treatment (the AVERROES trial), 932 patients who had previously used warfarin were included because the INR could not be maintained in the therapeutic range. 815 (15%) patients were included solely for refusal to take warfarin, and 178 patients with previous serious bleeding or other adverse event whilst taking warfarin were given apixaban. 3. There is presently very limited experience in the use of NOACs in patients for whom warfarin is considered too risky. The lower rate of major bleeding with the 110 mg BD dose of dabigatran should not be interpreted as a general indication to prefer dabigatran to warfarin for patients with a higher than average bleeding risk. Using stroke risk scores such as CHADS 2 or CHA 2 DS 2 -VASc and the bleeding risk score HAS-BLED is recommended when making individualised assessments about the appropriateness of anticoagulation, as a prelude to then considering which anticoagulant to use. 4. There is no specific antidote for patients taking NOACs who present with haemorrhage requiring emergency treatment. Advice on the management of haemorrhage or suspected overdose is included on Page As relatively new drugs, all the NOACs carry a black triangle. There are no long term safety or effectiveness data for these drugs beyond the approximate 2 year average in the original trials. Warfarin has over 50 years of accumulated clinical experience. 6. Dabigatran and apixaban must be taken twice daily. Rivaroxaban or warfarin are taken once daily. 7. Dabigatran is not suitable for inclusion within a compliance aid (e.g. blister pack) as the capsules are moisture sensitive and should not be stored outside their packaging. There are four categories of people in which the new oral anticoagulants may be a useful option: 1. People with AF not taking warfarin because of allergy or intolerance, or in circumstances where routine INR monitoring may be impractical (provided that monitoring of renal and/or liver function is still practicable). 2. People with AF currently taking warfarin who, despite evidence of good compliance with medication and monitoring, have poor anticoagulant control or other practical difficulties with the treatment such that stopping warfarin is being considered for safety reasons or concern regarding lack of efficacy. This group represents a significant proportion of patients with AF, most of whom are at a high risk of stroke without anticoagulation. Patients should be reviewed on an individual basis to decide whether a NOAC would be an appropriate treatment option taking into consideration the patient s time in the therapeutic range (TTR) on warfarin. Measures proven to improve TTR for a significant proportion of people (such as self-testing or selfmanagement, using a point-of-care device such as Coaguchek ) may be the preferred option rather than a switch to another agent. Published data from the RE-LY trial indicate that the clinical advantage of dabigatran was greatly diminished in centres in the trial with a TTR >72% (the UK average centre-specific TTR was 72%). In the ROCKET-AF trial comparing rivaroxaban with warfarin, the TTR in the warfarin arm was an average of 55% worldwide. 3. People with AF at risk of drug interactions. Page 3 of 12
4 A NOAC may be useful in patients where concomitant medication increases the risk of significant interactions with warfarin. NOACs should not be used with ketoconazole, itraconazole, carbamazepine, phenytoin, phenobarbital, St John s Wort or rifampicin. Dabigatran should also not be used with clarithromycin, ciclosporin or tacrolimus, and the dose should be reduced when used with amiodarone, dronedarone, verapamil or quinidine. Rivaroxaban and apixaban should not be used with voriconazole, posaconazole or HIV protease inhibitors, and rivaroxaban should not be used with dronedarone. 4. People with AF who have never taken warfarin. NICE guidance states that it is not reasonable to expect all patients to be tried on warfarin before a NOAC is considered. Patients are not obliged to have a trial of warfarin but prescribers may feel in consultation with their patient that a well established drug with which they have substantial experience may be a more appropriate choice. Some people with AF have previously been recommended to take aspirin instead of warfarin based either on their risk assessment for stroke (using CHADS 2 or similar) or their risk of bleeding. For the former category, recent expert guidelines recommend that anticoagulation is appropriate for all people with AF over the age of 65, or those under the age of 65 with a CHA 2 DS 2 -VASc score of 1 or more*. For the latter category, there may be modifiable risk factors for bleeding that can be addressed (identified using the HAS- BLED score) such that anticoagulation can then be safely introduced. Recent guidelines no longer recommend the use of aspirin to prevent thromboembolic events in people with AF, and people taking aspirin solely for this indication should be *unless reviewed the score as of a 1 matter arises purely of priority. from female sex. Page 4 of 12
5 Decision-making Guide for Anticoagulation in Non-valvular Atrial Fibrillation Person with AF (paroxysmal, persistent or permanent) Moderate-high risk of stroke: Aged over 65 OR Aged under 65 with CHA 2 DS 2 -VASc score 1 Yes N o CHA 2DS 2-VASc stroke risk score C Congestive Heart Failure/ LV dysfunction 1 H Hypertension 1 A Age 75 years 2 D Diabetes mellitus 1 S Stroke/TIA/previous embolism 2 V Vascular disease (MI, PVD) 1 A Age years 1 Sc Sex category: female 1 Maximum 9 points Truly low risk : No antithrombotic treatment HAS-BLED <3 Assess risk of bleeding Assess relative contraindications and cautions with anticoagulation using HAS-BLED score (0-9) HAS-BLED 3 Address any modifiable factors e.g alcohol and/or BP reduction, concomitant medications etc. Absolute contraindication to anticoagulation: No antithrombotic treatment HAS-BLED bleeding risk score H Hypertension (SBP>160) 1 A Abnormal renal or liver function (1 point each) 1 or 2 S Previous Stroke 1 B Bleeding history 1 L Labile INRs (TTR <60%) 1 E Elderly (aged >65) 1 D Drugs (aspirin, NSAIDs) or alcohol abuse (1 point each) 1 or 2 Maximum 9 points Recommend anticoagulation (with warfarin, dabigatran, rivaroxaban or apixaban) Note that at almost any level of HAS-BLED score, the benefits of anticoagulation outweigh the risks Unmodifiable high bleeding risk: No antithrombotic treatment Warfarin may be the preferred option for those people with AF: Who are currently well controlled on warfarin Who have never taken an anticoagulant (after discussing risks and benefits with the patient) Who are at risk of drug interactions with a novel oral anticoagulant Who have a CrCl (egfr) <30 ml/min Dabigatran, rivaroxaban or apixaban may be the preferred option for those people with AF: Who are not taking warfarin because of allergy or intolerance, or in circumstances where routine INR monitoring may be impractical (provided that monitoring of renal and liver function is still practicable) Who are currently taking warfarin but, despite evidence of good compliance with medication and monitoring, have poor anticoagulant control or other practical difficulties with the treatment Who are at risk of drug interactions with warfarin Who have never taken an anticoagulant (after discussing risks and benefits with the patient) Page 5 of 12
6 What about people with AF who are currently well controlled on warfarin? Published data from the RE-LY trial indicate that the clinical advantage of dabigatran was greatly diminished in centres in the trial with a TTR >72%, and in the ROCKET-AF trial of rivaroxaban versus warfarin, the worldwide average TTR in the warfarin comparator arm was a comparatively poor 55%. Thus people with stable, good INR control (an annual TTR of >72%) are much less likely to gain any clinical benefit by switching to a NOAC. However the NICE guidance states that even people with very good control should not be refused a NOAC as a potential treatment option. Local expert opinion would be that this category would not be a priority for active switching. Initiating treatment with a novel oral anticoagulant (NOAC) The recommended daily dose of dabigatran is one 150 mg capsule twice daily. People aged 80 years or above should be treated with one 110 mg capsule twice daily due to the increased prevalence of renal impairment in this population. People who reach the age of 80 on dabigatran treatment should drop to the lower dose The recommended daily dose of rivaroxaban is one 20 mg tablet once daily. For people with CrCl of mls/min, 15 mg once daily should be given The recommended daily dose of apixaban is one 5 mg tablet twice daily. For people with CrCl of mls/min, or those aged 80 with serum creatinine >133 µmol/l or weight <60 kg, 2.5 mg twice daily should be given When switching from warfarin, the drug should be stopped and the new anticoagulant initiated at the appropriate dose when the INR drops below 2.0 for dabigatran and apixaban, or 3.0 for rivaroxaban Patient education prevention and management of bleeding Patients should be advised to carry an appropriate anticoagulant alert card. The current yellow NPSA Oral Anticoagulant Therapy card may be useful (a patient card is available for each NOAC) Patients and carers must have a copy of the relevant patient information leaflet Patients should be advised that in the event of haemorrhage or significant acute illness to OMIT their anticoagulant medication and seek urgent medical advice Patients need to understand the benefits and risks of the NOACs through fully informed decision making a copy of this guidance may be appropriate for some patients A forgotten dose of dabigatran may still be taken up to 6 hours prior to the next scheduled dose. From 6 hours prior to the next scheduled dose, the missed dose should be omitted. No double doses should be taken A forgotten dose of rivaroxaban should be taken immediately and continued as normal the following day. No double doses should be taken A forgotten dose of apixaban should be taken immediately and then continued as normal with the next scheduled dose. No double doses should be taken Overdose: oral activated charcoal if within 2 hours of ingestion. Dabigatran can be dialysed Assessment and hospital management of major bleeding (cerebral or GI) There is no agent clinically proven to reverse the effect of any NOAC, or to reduce bleeding associated with their use Determining the time since last dose of therapy as interruption of treatment may be sufficient. The estimated time for restoration of haemostasis after cessation of therapeutic doses with adequate renal function is usually within 12 hours for dabigatran and apixaban, and 24 hours for rivaroxaban Page 6 of 12
7 Initiate resuscitation with IV fluids, blood transfusion and other supportive measures as necessary Check FBC, U&E s and a coagulation screen (PT, Thrombin Time and APTT). If these tests are within the normal reference range it is likely that only a low level of the anticoagulant is present. However, standard clotting tests cannot be used to estimate the extent of the anticoagulant effect If bleeding cannot be controlled by the above measures, tranexamic acid (0.5-1 g 3 times daily IV) should be given if not contraindicated. Administration of prothrombin complex concentrate (PCC) can be considered, but there is very limited experience with the use of these products in patients taking new anticoagulants and this recommendation is based on limited non-clinical data. Prior to emergency surgery If possible, wait 12 hours (dabigatran) or 24 hours (rivaroxaban and apixaban) after the last dose In the event of thrombosis Wait 12 hours (dabigatran, apixaban) or 24 hours (rivaroxaban) after the last dose before switching to a parenteral anticoagulant. Rivaroxaban is also licensed for the treatment of acute DVT and PE (in a different dose). Guidance produced by the Peninsula Heart & Stroke Network in conjunction with Paul Hughes, Deputy Head of Prescribing, NHS Cornwall & IOS, January Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Appropriate use of anticoagulation therapy in patients with AF (atrial fibrillation) following TIA (transient ischaemic attack) or stroke Stroke Team SENTINEL STROKE NATIONAL AUDIT PROGRAMME Daily Bimonthly review at Stroke Operational Group Meeting Stroke Operational Group Meeting held weekly, led by manager Debra Shields At Stroke Operational Group Meetings, led by manager Debra Shields 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 7 of 12
8 Appendix 1. Summary Guidance - Decision-making Guide for Anticoagulation in Non-valvular Atrial Fibrillation Summary guidance published separately available via Document Library (search for Anticoagulants for Stroke or click here) Page 8 of 12
9 Appendix 2. Governance Information Document Title Date Issued/Approved: 02/07/2014 Peninsula Network Guidance on Novel Anticoagulants for Stroke and TIA Date Valid From: 02/07/2014 Date Valid To: 02/07/2017 Directorate / Department responsible (author/owner): Dr Katja Adie, Eldercare Department Daniel Nash, Medical Student Contact details: Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: The aim of this document to guide clinicians on use of novel anticoagulants for stroke and TIA (transient ischaemic attack) prevention in patients with AF (atrial fibrillation) in Cornwall. AF, TIA or stroke, novel anticoagulants RCHT PCH CFT KCCG Medical Director Date revised: 18/06/14 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Not applicable Stroke Operational Group Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Andrew Virr Not Required {Original Copy Signed} Internet & Intranet Intranet Only Clinical / Neurology and Stroke None Advanced Stroke Management Pathway, Stroke Thrombolysis, Secondary Prevention Guidelines Stroke and TIA, Page 9 of 12
10 Training Need Identified? Stroke and TIA Care pathway, Peninsula Referral Guidelines for Early Decompressive Surgery in Acute Ischaemic Stroke No Version Control Table Date Version No 2014 V1.0 Initial Issue Summary of Changes Changes Made by (Name and Job Title) K Adie, consultant D Nash, medical student All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 10 of 12
11 Appendix 3.Initial Equality Impact Assessment Screening Form Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: Peninsula Network Guidance on Novel Anticoagulants for Stroke and TIA Management Directorate and service area: Existing Name of individual completing Telephone: assessment: K Adie 1. Policy Aim* The aim of this document to guide clinicians on use of novel anticoagulation agents following stroke or TIA in patients with Atrial fibrillation. 2. Policy Objectives* The guidance enables clinical staff to prevent further cerebrovascular events. 3. Policy intended Gold standard stroke care Outcomes* 5. How will you SENTINEL STROKE NATIONAL AUDIT PROGRAMME measure the outcome? Monthly board report 5. Who is intended to Patients with new stroke or TIA with AF in Cornwall benefit from the Policy? 6a. Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b. If yes, have these groups been consulted? This is a new policy and has been widely consulted Clinicians at RCHT, GPs, Managers, Stroke survivors, pharmacists This is not a procedure but a clinical guideline. It has been signed off by the stroke operational group (see notes of meeting 28/03/2014. c. Please list any groups who have been consulted about this procedure. *Please see Glossary 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Page 11 of 12
12 Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment Keep one copy and send a copy to Matron, Equality, Diversity and Human Rights, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Chyvean House, Penventinnie Lane, Truro, Cornwall, TR1 3LJ A summary of the results will be published on the Trust s web site. Signed Date Page 12 of 12
Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
CLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to assist decision making of whether anticoagulants
STROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing)
STROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing) 1. Aim/Purpose of this Guideline The aim of this document to inform clinicians
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
HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation
NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016 Version 1.4 EQIA Yes 01/06/2012
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
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME 1. Aim/Purpose of this Guideline This guideline is for the management of Adult patients with Diabetes Mellitus
NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION
Version 3 August 2014 NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION Dorset CCG commissions the use of newer oral anti-coagulants in accordance
Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0
Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0 January 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Ownership
NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation
NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 06/06/2012 Review Date 06/06/2014 Version 1.1 EQIA Yes /
VOLUME No: 21 04 written by Sara Wilds & Kathryn Buchanan. Date of issue: June 2012 (updated November 2012 following NICE TA 256)
Prescribing Points A NEWSLETTER FOR ALL HEALTH CARE PROFESSIONALS IN OXFORDSHIRE, WRITTEN BY THE MEDICINES MANAGEMENT TEAM, OXFORDSHIRE PCT, JUBILEE HOUSE, OXFORD BUSINESS PARK SOUTH, OXFORD, OX4 2LH.
This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital
CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS USING INSULIN PUMP THERAPY (Continuous Subcutaneous Insulin Infusion (CSII)), DURING ADMISSION TO HOSPITAL 1. Aim/Purpose of this
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
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
Clinical Guideline for the Perioperative Steroid Replacement
Clinical Guideline for the Perioperative Steroid Replacement 1. Aim/Purpose of this Guideline 1.1. This document provides guidelines for the safe management, within the theatre environment, of patients
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
NORTH WEST LONDON GUIDANCE ANTITHROMBOTIC MANAGEMENT OF ATRIAL FIBRILLATION
North West London CardioVascular & Stroke Network NORTH WEST LONDON GUIDANCE ON ANTITHROMBOTIC MANAGEMENT OF ATRIAL FIBRILLATION Key Messages 1. Efforts should be made to identify patients with Atrial
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
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:
SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline
SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline is for the management of sepsis in Infants and children. For full guidance please see the Surviving
Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
CLINICAL GUIDELINE FOR SECONDARY PREVENTION AFTER STROKE OR TIA (PRIMARY AND SECONDARY CARE CORNWALL) MANAGEMENT 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR SECONDARY PREVENTION AFTER STROKE OR TIA (PRIMARY AND SECONDARY CARE CORNWALL) MANAGEMENT 1. Aim/Purpose of this Guideline The aim of this document to inform clinicians on management
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
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,
NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation 1
Accounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0
Accounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0 June 2015 Table of Contents Accounts Receivable - Guidance to staff responsible
TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation 1 Name of Commissioning
Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman
DID NOT ATTEND (DNA) OR BOOKED LATE FOR ANTENATAL CARE - CLINICAL GUIDELINE Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman Woman has DNA an appointment Document
CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR INJURY UNITS IN CORNWALL
CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR 1. Aim/Purpose of this Guideline This Protocol applies to Registered Healthcare Practitioners in the Minor
Dorset Cardiac Centre
P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February
CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start
CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start 1. Assemble all your equipment before you start. 2. Explain and discuss the procedure with
Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options?
Patient decision aid Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options? http://guidance.nice.org.uk/cg180/patientdecisionaid/pdf/english Published: June 2014 About
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
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
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,
Title 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
2.1 When a breastfeeding woman is admitted to hospital, the support she needs depends on the nature of her illness and the treatment needed
CARE OF BREASTFEEDING WOMEN ADMITTED TO HOSPITAL, CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 Breastfeeding is known to be one of the most powerful health protective influences and as such,
All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation
All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation October 2013 This report has been prepared by a multiprofessional collaborative group, with support
Guidance on Leases and other Agreements V4.0
Guidance on Leases and other Agreements V4.0 August 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities...
Prescriber Guide. 20mg. 15mg. Simply Protecting More Patients. Simply Protecting More Patients
Prescriber Guide 20mg Simply Protecting More Patients 15mg Simply Protecting More Patients 1 Dear Doctor, This prescriber guide was produced by Bayer Israel in cooperation with the Ministry of Health as
Birmingham, Sandwell and Solihull Cardiac and Stroke Network. Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement
Birmingham, Sandwell and Solihull Cardiac and Stroke Network Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement Introduction This guidance informs prescribers and commissioners
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
GRASP-AF Coming to a PCT near you.
GRASP-AF Coming to a PCT near you. ADAS Anticoagulation dosing advisory service Blackpool Teaching Hospitals Trust Sean O'Brien; Anticoagulation Specialist BMS Grasp-AF and the implications on our Anticoagulation
CLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline This guideline is for the management of for the management of Adult patients with Diabetes
CLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline:
CLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline: 1.1. This protocol applies to Advanced Nurse Practitioners (Hepatology) employed by RCHT
2.1. Applicable areas: Royal Cornwall Hospitals Trust; Neonatal Unit and Delivery Suite
ADVANCED NEONATAL NURSE PRACTITIONERS (ANNPs) BLOOD COMPONENT AND BLOOD PRODUCT REQUESTING PROTOCOL NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 The purpose of this protocol is to guide
NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST
NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST NGAIRE IS 70 YEARS OLD AND IN AF. SHE HAS NO MURMURS, NORMAL BLOOD PRESSURE, EGFR OF 65ML/MIN AND NO SIGNIFICANT PAST MEDICAL HISTORY. REGARDING
CLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline 1.1. Venesection is a clinical procedure commonly performed in the Haematology
MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization
MEDICAL ASSISTANCE HBOOK PRI AUTHIZATION OF PHARMACEUTICAL SERVICES I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants
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
NOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions
AC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions FAQ document jointly prepared by NHSGGC Haematology Service & Medicines Infmation On behalf of the Heart MCN
MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization
MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants which meet any of the following conditions
Procedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging Examinations under IR(ME)R
Procedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging V3.0 December 2013 Page 1 of 11 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope...
Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation.
South West Essex Rivaroxaban Shared Care Guideline (SCG) Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation. Introduction
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
NHS 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
Guidance on Stocktaking V4.0
V4.0 November 2015 Summary. Stocktaking is carried out to for accounting purposes, identification of over/under stocking, identify obsolete or damaged stock. A physical check of stocks must be undertaken
Prevention of stroke in patients with atrial fibrillation
www.sign.ac.uk Prevention of stroke in patients with atrial fibrillation A guide for primary care January 2014 Evidence Contents 1 Introduction... 1 2 Detection...2 3 Risk stratification... 3 4 Treatment
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
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
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.
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
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
Version 8, 25 April 2013
Hertfordshire Implementation of NICE TAs 249, 256 and 275 Apixaban, dabigatran and rivaroxaban, novel oral anticoagulants (NOACs) for the prevention of stroke and systemic embolism in non-valvular atrial
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
NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues
NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues Andy Hutchinson Medicines Education Technical Adviser NICE Medicines and Prescribing Centre Note: this is
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
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Implementation of NICE TA 261 Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism Contents 1. Executive summary 2. Introduction
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
East Kent Prescribing Group
East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal
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
2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,
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
Dabigatran SCG for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation
South West Essex Dabigatran Shared Care Guideline (SCG) Dabigatran SCG for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation Introduction Indication and Licensing
DABIGATRAN 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)
Dabigatran (Pradaxa) Guidelines
Dabigatran (Pradaxa) Guidelines Dabigatran is a new anticoagulant for reducing the risk of stroke in patients with atrial fibrillation. Dabigatran is a direct thrombin inhibitor, similar to warfarin, without
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
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
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) The prevention of stroke and systemic embolism in atrial fibrillation (AF) with warfarin and New Oral Anticoagulants Warfarin remains the first-line option
1.1. Safe and effective use of intermittent pneumatic compression to prevent DVT and PE in stroke patients
CLINICAL GUIDELINE FOR PREVENTION OF DEEP VENOUS THROMBOSIS (DVT) AND PULMONARY EMBOLI (PE) IN STROKE PATIENTS USING INTERMITTENT PNEUMATIC LEG COMPRESSION 1. Aim/Purpose of this Guideline 1.1. Safe and
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
Hertfordshire guidelines for oral anticoagulation of patients with non-valvular AF
Hertfordshire guidelines for oral anticoagulation of patients with non-valvular AF *GUIDELINES FOR ORAL ANTICOAGULATION OF PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION (AF) TO PREVENT STROKE Contents
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
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
An Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban)
Sabiha Fatima Hussaini Sabiha.hussaini@salisbury.nhs.uk An Audit of the Documentation and Correct Referral of Patients on Initiation of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) April
PREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline
PREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline All clinical staff working in the Division of women, children & sexual health to provide evidence based guidance
Atrial Fibrillation An update on diagnosis and management
Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.
MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE
MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. To provide monitoring and treatment guidance for medical and nursing staff
What You Should NOAC About the New Anticoagulants. Dr Calum Young Cardiologist
What You Should NOAC About the New Anticoagulants Dr Calum Young Cardiologist Overview The Burden of AF What s Wrong With Warfarin? The Era of NOACs NOACs in New Zealand Clinical Trials with NOACs Potential
Anticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions
Anticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions What is atrial fibrillation?...2 What are dabigatran, rivaroxaban and apixaban and what are they used for?...2
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
Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)
Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep
Novel Oral Anticoagulants and Warfarin Comparative evidence and Information for Prescribers
Novel Oral Anticoagulants and Warfarin Comparative evidence and Information for Prescribers How does it work? Dose and Administration Monitoring Warfarin Dabigatran Rivaroxaban Apixaban Warfarin has an
The Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0
The Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0 January 2013 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3.
Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM
Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM This report was commissioned by the NIHR HTA Programme as project number 12/78
Guidelines for the use of existing and New Oral Anticoagulants (NOAC) in the management of Non-Valvular Atrial Fibrillation (AF)
Guidelines for the use of existing and New Oral Anticoagulants (NOAC) in the management of Non-Valvular Atrial Fibrillation (AF) July 14 Version 1 September 2012 Updated to v1.1 due to new contraindication
Novel Anticoagulation Agents DISCLOSURES. Objectives ATRIAL FIBRILLATION TRIALS. NOAC Comparison 6/12/2015
Novel Anticoagulation Agents DISCLOSURES James W. Haynes, MD Department of Family Medicine Univ of TN Health Science Center (Chattanooga) Objectives Understand mechanism of action behind the NOAC agents
Implementation of NICE TAs 261 and 287
Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group Northampton General Hospital NHS Trust Northamptonshire Healthcare Foundation Trust Implementation