Antiplatelet and Antithrombotics From clinical trials to guidelines
|
|
- Samuel Underwood
- 8 years ago
- Views:
Transcription
1 Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR
2 One of the big stories in 2011 RE-LY: Dabigatran ROCKET: Rivaroxaban ARISTOTLE: Apixaban Triology/TRITON : Prasugrel DISPERSE/PLATO: Ticagrelor CURRENT: Clopidogrel OASIS-5: Fomdapurinox HORAIZONS: Bivalurodin ATLAS: Rivaroxaban APPRAISE-2 Apixaban AF ACS/PCI Vit.K antagonist: Narrow therapeutic range Drug &food interaction Bleeding/ monotoring Clopidogrel resistance MACEs Stent thrombosis Variable response Drug-drug Dose/duration
3 AF
4 Recent anticoagulants: Mechanisms
5 Dabigatran A pro drug rapidly converted to active thrombin (IIa) inhibitor Independent on Cytochrome 450 Renally excreted 150 mg, 110 mg and 75 mg No monitoring
6 RE-LY : Dabigatran etexilate Inclusion criteria Patients with non-valvular atrial fibrillation (AF), at moderate to high risk of stroke, or systemic embolism with at least one additional risk factor previous ischemic stroke, TIA, or systemic embolism, left ventricular dysfunction, age >=75 years, age >=65 with either diabetes mellitus, history of coronary artery disease or hypertension 18,113 Pts with non valve. AF randomised to fixed dose Dabigatran without lab. monitoring Vs Warfarin ( INR 2-3) 110 and 150 mg dosages were tested Mean CHADS2 risk was mg bid showed 34% RR compared to Warfarin wit same bleeding risk (nearly eliminate stroke if against placebo) 110 mg BID was non inferior to warfarin with 20% RR in bleeding
7 Stroke Prevention in Atrial Fibrillation: ROCKET AF ROCKET AF: Rivaroxaban versus warfarin First direct Xa inhibitor Non inferior to warfarin with less bleeding Single dose despite short half life Risk of stroke on discontinuation No guideline for transition to other antithrombotics
8 Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation (ARISTOTLE) Apixaban vs. Warfarin in Patients With Atrial Fibrillation Direct xa inhibitor No lab. Monitoring Previously tested against Asp. In AF 5mg and 2.5 mg BID 18,201 Pts with non valvular AF N Engl J Med 2011;365: Compared to warfarin, apixaban reduced the risk of stroke or systemic embolization by 21%, major bleeding by 31%, and death from any cause by 11% in patients with AF.
9 ACC/AHA 2011 Focused Update Recommendation: New recommendation Class1 Dabigatran is useful as an alternative to warfarin for the prevention of stroke and systemic thromboembolism in patients with paroxysmal to permanent AF and risk factors for stroke or systemic embolization who do not have a prosthetic heart valve or hemodynamically significant valve disease, severe renal failure (creatinine clearance <15 ml/min) or advanced liver disease (impaired baseline clotting function) (3). (Level of Evidence: B) 150 mg twice daily with Crt. Clearance more than 30 ml/min 75 mg BID if ml/min For less than 15 ml/min? Net benefit better with high CHADS2 SCORE
10 ACS/PCI
11
12 Antiplatelets
13
14 Wiviott SD, Braunwald E, McCabe CH, et al. N Eng J Med 2007; 357: End point Cardiovascular death/mi/ stroke* TRITON-TIMI 38 results (ACS for PCI) Prasugrel (%) Clopidogrel (%) HR (95% CI) ( ) p <0.001 Cardiovascular death ( ) 0.31 Nonfatal MI ( ) Nonfatal stroke ( ) < Death from any cause ( ) 0.64 Urgent TVR ( ) Stent thrombosis ( ) Bleed requiring transfusion *Primary ( ) end point CABG-related TIMI major bleed b ( ) <0.001 <0.001 <0.001 <0.001
15 Prasugrel Better prevention of MI and stent thrombosis in ACS Pts under going PCI (More bleeding) For stent TH despite ASP/clopidogrel therapy High risk in the elderly and low body Wt. TRIOLOGY ACS ( high risk medically managed population
16
17 Clopidogrel
18 PLATO: Patient disposition in the trial Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Acute Coronary Syndromes Intended for Reperfusion With Primary Percutaneous Coronary Intervention A Platelet Inhibition and Patient Outcomes (PLATO) Trial Subgroup Analysis 7544 STEMI Steg P G et al. Circulation 2010;122: Copyright American Heart Association
19 Time-related Kaplan Meier estimates of the time to first occurrence of (A) the primary end point (incidence of MI, stroke, or vascular death; HR, 0.87; 95% CI, 0.75 to 1.01; P=0.07) and each of its components; B, cardiovascular death (HR, 0.83; 95% CI, Steg P G et al. Circulation 2010;122: Copyright American Heart Association
20 Time-related Kaplan Meier estimate for major bleeding according to the PLATO definition (HR, 0.98; 95% CI, 0.83 to 1.14; P=0.76). Steg P G et al. Circulation 2010;122: Copyright American Heart Association
21
22 Glycoprotein (GP)IIb/IIIa blockers No routine up-stream For high risk PCI (+ve Troponin- Thrombus) and low bleeding risk
23
24 ANTICOAGULANTS UFH LMWH Fondaparinox Bivalurodin
25 OASIS Fondaparinux 2.5 mg bid Vs Enopxarin 1mg/kg bid Pts wit ACS Non inferiority DBRT Same protective effect Significantly less bleeding with fondaparinux 2.2% compared to Enoxaparin 4,15
26 Bivalurudin: Main Results From HORIZONS-AMI Bonaca, M. P. et al. J Am Coll Cardiol 2009;54: Copyright 2009 American College of Cardiology Foundation. Restrictions may apply.
27
28 One of the big stories in 2011 RE-LY: Dabigatran ROCKET: Rivaroxaban ARISTOTLE: Apixaban Triology/TRITON : Prasugrel DISPERSE/PLATO: Ticagrelor CURRENT: Clopidogrel OASIS-5: Fomdapurinox HORAIZONS: Bivalurodin ATLAS: Rivaroxaban APPRAISE-2 Apixaban AF ACS/PCI Vit.K antagonist: Narrow therapeutic range Drug &food interaction Bleeding/ monotoring Clopidogrel resistance MACEs Stent thrombosis Variable response Drug-drug Dose/duration
29 THANK YOU ASRAF REDA, MD, FESC
New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013
New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7
More informationAntiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care
Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:
More information3/25/14. To Clot or Not What s New In Anticoagulation? Clotting Cascade. Anticoagulant drug targets. Anita Ralstin, MS CNS CNP. Heparin.
To Clot or Not What s New In Anticoagulation? Anita Ralstin, MS CNS CNP 1 Clotting Cascade 2 Anticoagulant drug targets Heparin XI VIII IX V X VII LMWH II Warfarin Fibrin clot 1 Who Needs Anticoagulation
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:
STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention
More informationNone. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015
Financial Disclosure Information Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Dual Antiplatelet
More informationThe Anti coagulated Patient: The Cardiologist s View. February 28, 2015
The Anti coagulated Patient: The Cardiologist s View February 28, 2015 Conflicts Dr. McMurtry has no conflicts to disclose. CanMeds Medical Expert (as Medical Experts, physicians integrate all of the CanMEDS
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION
STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients
More informationLong term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial
Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial Camillo Autore Università di Roma Sapienza II Facoltà di Medicina e Chirurgia
More 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 informationThe author has no disclosures
Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author
More informationAHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation
AHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation A Statement for Healthcare Professionals from the American Heart Association/American Stroke
More 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 information22-Oct-14. Oral Anticoagulation Which Drug for Which Patient in the era of New Oral Anti-coagulants. Atrial Fibrillation. AF as an embolic risk factor
Oral Anticoagulation Which Drug for Which Patient in the era of New Oral Anti-coagulants Dr Scott McKenzie BSc MBBS FRACP FCSANZ Cardiologist, Vascular Physician, Telehealth Specialist, Advanced Heart
More informationWOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION. Van Crisco, MD, FACC, FSCAI First Coast
WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION Van Crisco, MD, FACC, FSCAI First Coast Conflicts of Interest I have been a paid consultant and speaker for AstraZeneca, makers of
More informationL'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy ISO 9001
L'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy Scientific Advances and Cardiovascular Mortality Nabel and
More informationAnticoagulants in Atrial Fibrillation
Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives
More informationRR 0.88 (95% CI: 0.77 1.00) P=0.051 (superiority) 3.75
ALL-CAUSE MORTALITY RR 0.88 (95% CI: 0.77 1.00) P=0.051 (superiority) Rate per year (%) 5.0 4.0 3.0 2.0 1.0 0 3.64 D150 mg BID 3.75 D110 mg BID RR 0.91 (95% CI: 0.80 1.03) P=0.13 (superiority) 4.13 Warfarin
More informationRivaroxaban for acute coronary syndromes
Northern Treatment Advisory Group Rivaroxaban for acute coronary syndromes Lead author: Nancy Kane Regional Drug & Therapeutics Centre (Newcastle) May 2014 2014 Summary Current long-term management following
More informationAnticoagulation Dosing at UCDMC Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h
Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h See EMR adult VTE prophylaxis CI order set Enoxaparin See service specific dosing Assess
More informationNovel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations
Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant
More informationxaban) Policy covered: Coverage of following criteria: the following those who meet the or Hip Xarelto is For those impacted by this policy.
Xarelto (rivarox xaban) Policy Number: 5.01.575 Origination: 06/2014 Last Review: 07/2015 Next Review: 07/2016 Policy BCBSKC will provide coverage for Xarelto when it is determined to be medically necessary
More informationUpdate on Antiplatelets and anticoagulants. Outlines. Antiplatelets and Anticoagulants 1/23/2013. Timir Paul, MD, PhD
Update on Antiplatelets and anticoagulants Timir Paul, MD, PhD Antiplatelets Indications Doses Long term use (beyond 12 months) ASA and combination use of NSAIDS ASA resistance Plavix resistance Plavix
More informationNew Oral AntiCoagulants (NOAC) in 2015
New Oral AntiCoagulants (NOAC) in 2015 William R. Hiatt, MD Professor of Medicine and Cardiology University of Colorado School of Medicine President CPC Clinical Research Disclosures Received research
More informationAnticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014
Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014 Atrial Fibrillation 2 Atrial Fibrillation The most common arrhythmia encountered
More 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 informationRivaroxaban. Practical Experience in the Cardiology Setting. Bernhard Meier, Bern Bayer Satellite Symposium Cardiology Update Davos February 11, 2013
Rivaroxaban Practical Experience in the Cardiology Setting Bernhard Meier, Bern Bayer Satellite Symposium Cardiology Update Davos February 11, 2013 Overview of phase III clinical trials of new oral anticoagulants
More informationGoals 6/6/2014. Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs. Ashkan Babaie, MD
Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs Ashkan Babaie, MD Arrhythmia Service Providence Heart Clinic June 8 th, 2014 Goals Discuss the data behind approval of NOACs
More informationCardiology Update 2014
Cardiology Update 2014 Update on the Novel Oral Anticoagulants (NOACS) Raymond Kawasaki, MD AMG Cardiology December 6, 2014 Disclosures I have no disclosures relevant to this presentation Contents I. The
More information1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF
Objectives Atrial Fibrillation and Prevention of Thrombotic Complications: Therapeutic Update Andrea C. Flores Pharm.D Pharmacy Resident at the Miami VA Healthcare System Review the epidemiology, pathophysiology
More informationDual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute
Dual Antiplatelet Therapy Stephen Monroe, MD FACC Chattanooga Heart Institute Scope of Talk Identify the antiplatelet drugs and their mechanisms of action Review dual antiplatelet therapy in: The medical
More informationΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ. Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν
ΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν The AF epidemic Mayo Clinic data (assuming a continued increase in the AF incidence) Mayo
More informationKevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013
Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Family physician with Rivergrove Medical Clinic Practice in the north end since 1985 Medical Director of the Wellness
More informationOptimizing Anticoagulation Selection for Your Patient. C. Andrew Brian MD, FACC NCVH 2015
Optimizing Anticoagulation Selection for Your Patient C. Andrew Brian MD, FACC NCVH 2015 Who Needs to Be Anticoagulated and What is the Patient s Risk? 1. Atrial Fibrillation ( nonvalvular ) 2. What regimen
More informationTHE BENEFITS OF RIVAROXABAN (XARELTO ) ACROSS MULTIPLE INDICATIONS AND THE RELEVANCE TO CARDIOLOGISTS
THE BENEFITS OF RIVAROXABAN (XARELTO ) ACROSS MULTIPLE INDICATIONS AND THE RELEVANCE TO CARDIOLOGISTS Ingo Ahrens, Christoph Bode Cardiology and Angiology I, Heart Center Freiburg University, Freiburg,
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
More 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 informationCurrent Controversies in Management of Anticoagulation for Atrial Fibrillation
Current Controversies in Management of Anticoagulation for Atrial Fibrillation Cheri Silverstein Fadlon, MD MSCR Assistant Professor of Internal Medicine, COMP Cardiologist, Western Diabetes Institute
More informationNon- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs
Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose Warfarin vs the NOACs Dr. Lori McIntosh D.O. Board Certified Neurologist Objectives Be able to list the current options of
More informationManagement of atrial fibrillation. Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD
Management of atrial fibrillation Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD Antithrombotic therapy in atrial fibrillation Satchana Pumprueg, MD AF has serious consequences Independent
More informationDuration of Dual Antiplatelet Therapy After Coronary Stenting
Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are
More informationDabigatran 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
More informationDUAL ANTIPLATELET THERAPY. Dr Robert S Mvungi, MD(Dar), Mmed (Wits) FCP(SA), Cert.Cardio(SA) Phy Tanzania Cardiac Society Dar es Salaam Tanzania
DUAL ANTIPLATELET THERAPY Dr Robert S Mvungi, MD(Dar), Mmed (Wits) FCP(SA), Cert.Cardio(SA) Phy Tanzania Cardiac Society Dar es Salaam Tanzania DUAL ANTIPLATELET THERAPY (DAPT) Dual antiplatelet regimen
More informationHow To Treat Aneuricaagulation
Speaker Introduction Jessica Wilhoite, PharmD, BCACP Doctor of Pharmacy: Purdue University Postgraduate Residency Training: PGY1 Pharmacy Practice St. Vincent Hospital PGY2 Ambulatory Care St. Vincent
More informationApixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial
Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,
More informationAnticoagulation Therapy Update
Anticoagulation Therapy Update JUDY R. WALLING, FNP-BC ARRHYTHMIA MANAGEMENT MUSC CARDIOLOGY Outline Who do we anticoagulate? Review classes of Anticoagulants Review examples of Anticoagulants Review CHADS2
More information2016 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,
More informationGetting smart about dyspnea and life saving drug therapy in ACS patients. Kobi George Kaplan Medical Center Rehovot
Getting smart about dyspnea and life saving drug therapy in ACS patients Kobi George Kaplan Medical Center Rehovot 78 year old female Case description Presented with resting chest pain and dyspnea Co morbidities:
More 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 informationThree new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
More informationAnalyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation
Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 29,
More informationIl punto sulla terapia antitrombotica nelle sindromi coronariche acute
Santa Margherita Ligure TIGULLIO CARDIOLOGIA 2012 16-17 Febbrajo 2012 Il trattamento dell infarto miocardico acuto ad ST spraslivellato: dal territorio al laboratorio di emodinamica Il punto sulla terapia
More informationManaging Anticoagulation for Atrial Fibrillation 2015
Managing Anticoagulation for Atrial Fibrillation 2015 Vikranth Gongidi, DO FACC FACOI Indian River Medical Center Vero Beach, FL Atrial Fibrillation Background and Guidelines Decisions to anticoagulate
More 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 informationThrombosis and Hemostasis
Thrombosis and Hemostasis Wendy Lim, MD, MSc, FRCPC Associate Professor, Department of Medicine McMaster University, Hamilton, ON Overview To review the important developments in venous thromboembolism
More informationAtrial Fibrillation: Stroke and Thromboprophylaxis. Derek Waller
Atrial Fibrillation: Stroke and Thromboprophylaxis Derek Waller Atrial Fibrillation in the Elderly: Risk of Stroke Framingham study AGE 50-59 60-69 70-79 80-89 Prevalence of AF % Attributable Risk of AF
More informationAnticoagulation in Atrial Fibrillation
Anticoagulation in Atrial Fibrillation Parag P. Patel, MD FACC Disclosures Eliquis Speakers Bureau 1 Clinical Scenario Ms. L is a 76F admitted to the stroke service with a dense right sided hemiparesis
More informationCardiovascular Subcommittee of PTAC Meeting held 27 February 2014. (minutes for web publishing)
Cardiovascular Subcommittee of PTAC Meeting held 27 February 2014 (minutes for web publishing) Cardiovascular Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology
More informationPrevention 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
More information2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2.
Anticoagulation dosing at UCDMC (SC=subcutaneously; CI=continuous infusion) Indication Agent Dose Comments Prophylaxis Any or No bleeding risk factors see adult heparin (VTE prophylaxis) IV infusion order
More informationBridging the Gap: How to Transition from the NOACs to Warfarin
Bridging the Gap: How to Transition from the NOACs to April 24 th 2015 UAN: 0048-0000-15-034-L01-P Amanda Styer, Pharm.D. Marion General Hospital, OhioHealth Objectives: 1. Review labeling regarding transition
More informationEast Kent Prescribing Group
East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal
More informationAnticoagulation For Atrial Fibrillation
Anticoagulation For Atrial Fibrillation New Agents In A New Era Arjun V Gururaj, MD Arrhythmia and Electrophysiology Nevada Heart and Vascular Center Disclosures Biotronik Speaker Clinical investigator
More informationWhat You Should NOAC About the New Anticoagulants. Dr Calum Young Cardiologist
What You Should NOAC About the New Anticoagulants Dr Calum Young Cardiologist Overview The Burden of AF What s Wrong With Warfarin? The Era of NOACs NOACs in New Zealand Clinical Trials with NOACs Potential
More informationTherapeutic Class Overview Oral Anticoagulants
Therapeutic Class Overview Oral Anticoagulants Therapeutic Class Overview/Summary: The oral anticoagulants, dabigatran etexilate mesylate (Pradaxa ), rivaroxaban (Xarelto ), and warfarin (Coumadin, Jantoven
More informationABOUT XARELTO CLINICAL STUDIES
ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the
More informationManagement of Antithrombotics with Procedures. Jordan Weinstein, MD
Management of Antithrombotics with Procedures Jordan Weinstein, MD Presenter Disclosure Information Cardiology Update 2013 I have no relevant financial interest and/or arrangement with industry. Novel
More informationFailure or significant adverse effects to all of the alternatives: Eliquis and Xarelto
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics
More informationNOAC s post Myocardial Infarction Peter Clemmensen MD, PhD, FESC, FSCAI Chief of Cardiology
NOAC s post Myocardial Infarction Peter Clemmensen MD, PhD, FESC, FSCAI Chief of Cardiology Department of Medicine Division of Cardiology Nykøbing F Hospital Denmark Disclosure of Conflict of Interest
More informationXarelto (Rivaroxaban)
Xarelto (Rivaroxaban) Hightly selective, reversible, direct oral FXa inhibitor Maxium concentratiion after 2 to 4 hrs High bioavailability(66%),increase with food ( suggest with food) 1/3 from renal excretion,
More informationCardiovascular Disease
Cardiovascular Disease 1 Cardiovascular Disease 1. More target specific oral anticoagulants (TSOAC) 2. Vorapaxar (Zonivity) 3. Continued noise about a polypill 4. WATCHMAN 3 1 2 3 4 Left Atrial Appendage
More informationHow to manage a patient who needs thrombolysis in acute stroke, ablation or angioplasty/stenting? Janet M McComb Freeman Hospital Newcastle upon Tyne
How to manage a patient who needs thrombolysis in acute stroke, ablation or angioplasty/stenting? Janet M McComb Freeman Hospital Newcastle upon Tyne What do the guidelines say? What happens with warfarin
More informationUpdates to the Alberta Human Services Drug Benefit Supplement
Updates to the Alberta Human Services Drug Benefit Supplement Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone
More informationClinical Practice Guideline for Anticoagulation Management
Clinical Practice Guideline for Anticoagulation Management This guideline is to inform practitioners of the Standard of Care for providing safe and effective anticoagulation management for ambulatory patients.
More informationrivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (756/12) Bayer PLC
rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (756/12) Bayer PLC 13 January 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS
More informationAntikoagulation und antithrombotische Therapie bei Herzerkrankungen
Antikoagulation und antithrombotische Therapie bei Herzerkrankungen Christian Sticherling Kardiologie Dimitrios Tsakiris Hämatologie Einsatz der Antikoagulation und antithrombotischen Therapie in der Kardiologie
More informationNew Approaches to, and Indications for, Antiplatelet Therapy
New Approaches to, and Indications for, Antiplatelet Therapy Kenneth A. Bauer, MD Professor of Medicine, Harvard Medical School Chief, Hematology Section, VA Boston Healthcare System Director, Thrombosis
More informationA PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS
A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS BRIAN CRYDER, PHARMD BCACP LEARNING OBJECTIVES AS A RESULT OF THIS PRESENTATION, THE AUDIENCE WILL BE ABLE TO 1. DISCUSS THE KEY DIFFERENCES BETWEEN
More informationOptimal Duration of Dual Antiplatelet Therapy
Optimal Duration of Dual Antiplatelet Therapy Luis A Guzman, MD, FACC, FSCAI Associate Professor of Medicine Director, Cardiac and Vascular Cath Lab University of Florida College of Medicine - Jacksonville
More informationAnticoagulation before and after cardioversion; which and for how long
Anticoagulation before and after cardioversion; which and for how long Sameh Samir, MD Cardiovascular medicine dept. Tanta faculty of medicine Atrial fibrillation goals of management Identify and treat
More informationNew Anticoagulants and GI bleeding
New Anticoagulants and GI bleeding DR DANNY MYERS MD FRCP(C) CLINICAL ASSISTANT PROFESSOR OF MEDICINE, UBC Conflicts of Interest None I am unbiased in the use of NOAC s vs Warfarin based on risk benefit
More 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 informationCommittee Approval Date: September 12, 2014 Next Review Date: September 2015
Medication Policy Manual Policy No: dru361 Topic: Pradaxa, dabigatran Date of Origin: September 12, 2014 Committee Approval Date: September 12, 2014 Next Review Date: September 2015 Effective Date: November
More informationEliquis. Policy. covered: Eliquis is. indicated to. reduce the. therapy. Eliquis is. superior to. of 32 to. Eliquis is AMPLIFY. nonfatal. physicians.
Eliquis (apixaban) Policy Number: 5.01.573 Origination: 06/2014 Last Review: 07/2015 Next Review: 07/2016 Policy BCBSKC will provide coverage for Eliquis when it is determined to be medically necessary
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 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 informationNIL. Dr Chuks Ajaero FMCP FRACP Cardiologist QEH, NALHN, SA Heart & Central Districts. Approach. Approach. 06-Nov-14
Stroke Prevention in Atrial Fibrillation: Commencing Non- Oral Anticoagulants in GP setting Dr Chuks Ajaero FMCP FRACP Cardiologist QEH, NALHN, SA Heart & Central Districts Disclosures NIL Classification
More informationPerioperative Bridging in Atrial Fibrillation: Is it necessary?
Perioperative Bridging in Atrial Fibrillation: Is it necessary? Jason B. Thompson M.D., Ph.D. August 29, 2015 2015 NCVH Birmingham Hypothesis: When bridging, risk of bleeding < risk systemic embolism (SE).
More informationPerspectives on the Selection and Duration of Dual Antiplatelet Therapy
Perspectives on the Selection and Duration of Dual Antiplatelet Therapy Dominick J. Angiolillo, MD, PhD, FACC, FESC, FSCAI Director of Cardiovascular Research Associate Professor of Medicine University
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 informationACC/AHA 2009 STEMI Guideline Focused Update and What s New in 2012 Guideline
ACC/AHA 2009 STEMI Guideline Focused Update and What s New in 2012 Guideline David Zhao, MD, FACC, FSCAI Professor of Medicine and Cardiac Surgery Harry and Shelley Page Professor in Interventional Cardiology
More informationDorset Cardiac Centre
P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February
More 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 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 informationOral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Brief Comparison of Four Agents
Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Brief Comparison of Four Agents Abbreviations AF: Atrial fibrillation ARISTOTLE: Apixaban for Reduction in Stroke and Other Thromboembolic
More informationObjectives. New and Emerging Anticoagulants. Objectives (continued) 2/18/2014. Development of New Anticoagulants
Objectives New and Emerging Anticoagulants Adraine Lyles, PharmD, BCPS Clinical Pharmacy Specialist VCU Medical Center Describe the pharmacology of the novel oral anticoagulants Discuss the clinical evidence
More informationNovel OAC s : How should we use them?
Novel OAC s : How should we use them? Jean C. Grégoire MD, FRCP(c), FACC, FACP Associate Professor, Université de Montréal, IntervenJonal Cardiologist, InsJtut de cardiologie de Montréal Disclosures Speaker
More informationElisabetta Toso, MD Dipartment of Medical Sciences University of Turin
Security and efficacy of Rivaroxaban in real life in the prevention of the stroke in non valvular AF patients: presentation of the results of the international study Xantus Elisabetta Toso, MD Dipartment
More informationCardiology Medications New Drugs, New Guidelines
Cardiology Medications New Drugs, New Guidelines Ken Kester, PharmD, JD Pharmacy Team Leader Nebraska Heart Hospital August 4, 2014 Cardiology Medications Objectives The attendee will understand Indications,
More informationXarelto (Rivaroxaban): Effective in a broad spectrum. Joep Hufman, MD Medical Scientific Liason
Xarelto (Rivaroxaban): Effective in a broad spectrum Joep Hufman, MD Medical Scientific Liason Xarelto : Effective in a broad spectrum Introduction Therapeutic areas SPAF VTE Prevention VTE treatment Practical
More informationDabigatran in Atrial Fibrillation Question and Answers document to inform commissioners
Dabigatran in Atrial Fibrillation Question and Answers document to inform commissioners West Midlands Commissioning Support Unit, Birmingham University /New Medicines Evaluation Unit, Keele University
More information