EINSTEIN DVT/PE IMPORTANT SAFETY INFORMATION

Size: px
Start display at page:

Download "EINSTEIN DVT/PE IMPORTANT SAFETY INFORMATION"

Transcription

1 EINSTEIN DVT/PE % INDICATIONS is indicated for the treatment of deep vein thrombosis (DVT). is indicated for the treatment of pulmonary embolism (PE). is indicated for the reduction in the risk of recurrence of DVT and of PE following initial 6 months treatment for DVT and/or PE. IMPORTANT SAFETY INFORMATION WARNING: (A) PREMATURE DISCONTINUATION OF INCREASES THE RISK OF THROMBOTIC EVENTS, (B) SPINAL/ EPIDURAL HEMATOMA A. PREMATURE DISCONTINUATION OF INCREASES THE RISK OF THROMBOTIC EVENTS Premature discontinuation of any oral anticoagulant, including, increases the risk of thrombotic events. If anticoagulation with is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. B. SPINAL/EPIDURAL HEMATOMA Epidural or spinal hematomas have occurred in patients treated with who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include: Use of indwelling epidural catheters Concomitant use of other drugs that affect hemostasis, such as non-steroidal antiinflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants, see Drug Interactions A history of traumatic or repeated epidural or spinal punctures A history of spinal deformity or spinal surgery Optimal timing between the administration of and neuraxial procedures is not known Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary. Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.

2 EINSTEIN DVT AND EINSTEIN PE TRIALS: PATIENTS AT A GLANCE EINSTEIN DVT AND EINSTEIN PE TRIALS: CLINICAL OUTCOMES DVT and PE Treatment Trial Design Single-Agent Treatment Approach EINSTEIN DVT* and EINSTEIN PE Study Designs 1,2 DVT trial population: objectively confirmed symptomatic proximal DVT without symptomatic PE (N=3449) PE trial population: objectively confirmed symptomatic PE with or without symptomatic DVT (N=4832) Randomization 15 mg twice daily Day 21 1 mg/kg twice daily for 5 days INR 2.5 (range ) 20 mg once daily Follow-up (rivaroxaban) At Least as Effective as Standard of Care ( ) Proven Noninferior for Treatment of DVT and/or PE 3 Time to first occurrence of the composite of recurrent DVT or nonfatal or fatal PE # DVT/PE Pooled Data Enoxaparin/warfarin The purpose of the DVT and PE treatment trials (EINSTEIN DVT and EINSTEIN PE) was to compare the efficacy and safety of (rivaroxaban) with standard therapy (, followed by warfarin) for the treatment of acute DVT and acute PE, respectively. 1,2 Primary efficacy outcome: symptomatic recurrent VTE Principal safety outcome: composite of major bleeding or clinically relevant nonmajor bleeding Cumulative Event Rate (%) Days (N=4150) Enoxaparin/warfarin (N=4131) Number of Patients at Risk EINSTEIN DVT Treatment Characteristics Pretreatment with LMWH, heparin, or fondaparinux before randomization 1 0 days: 27% 1 day: 69% 2 days: 4.1% EINSTEIN PE Treatment Characteristics Pretreatment with LMWH, heparin, or fondaparinux before randomization 2 0 days: 7.5% 1 day: 57.4% 2 days: 35% LMWH = low-molecular-weight heparin; VTE = venous thromboembolism. *The EINSTEIN DVT study was a randomized, open-label study to compare the effi cacy and safety of with standard therapy (, followed by warfarin).patients were eligible if they had acute, symptomatic, objectively confi rmed proximal DVT, without symptomatic PE. Patients were randomized from March 2007 to September The EINSTEIN PE study was a randomized, open-label study to compare the effi cacy and safety of with standard therapy ( + warfarin, followed by warfarin). Patients were eligible if they had an acute, symptomatic pulmonary embolism with objective confi rmation, with or without symptomatic DVT. Patients were randomized from March 2007 to March Baseline characteristics were similar in both treatment arms. 0 days pretreatment calculation: 100%-73%=27%. II 2% days pretreatment calculation: 3.9%+0.2%=4.1%. 2% days pretreatment calculation: 33.1%+1.9%=35%. # Intent-to-treat population. CONTRAINDICATIONS Active pathological bleeding Severe hypersensitivity reaction to (eg, anaphylactic reactions) WARNINGS AND PRECAUTIONS Increased Risk of Thrombotic Events After Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from to warfarin in clinical trials in atrial fibrillation patients. If is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. 2 3

3 EINSTEIN DVT AND EINSTEIN PE TRIALS: CLINICAL OUTCOMES EINSTEIN DVT AND EINSTEIN PE TRIALS: CLINICAL OUTCOMES Single-Agent Treatment Approach 46% Relative Risk Reduction in Major Bleeding Versus Standard of Care ( ) 3 Single-Agent Treatment Approach Rates in Key Bleeding Categories in the Pooled Analysis of the DVT and PE Treatment Trials* 3 j y j g Major Bleeding in the Pooled Analysis of the DVT and PE Treatment Trials* 3 Nonmajor Clinically Relevant # + Major Bleeding 3 Patient category Hazard Ratio (95% CI) vs Patient category Hazard Ratio (95% CI) vs All patients (n=8281) 0.54 ( ) 1.0 (40/4130) PERCENT 1.7 (72/4116) All patients (n=8281) 0.93 ( ) 9.4 (388/4130) PERCENT 10.0 (412/4116) Patients with cancer (n=597) 0.53 ( ) 2.8 (9/316) 5.0 (14/278) Patients with cancer (n=597) 0.93 ( ) 15.2 (48/316) 15.8 (44/278) Patients with previous DVT/PE (n=1610) Fragile patients (n=1573) 0.51 ( ) 0.27 ( ) 0.9 (7/788) 1.3 (10/788) 1.7 (14/813) 4.5 (35/779) Patients with previous DVT/PE (n=1610) Fragile patients (n=1573) 0.77 ( ) 0.85 ( ) 8.9 (70/788) 12.3 (97/788) 11.2 (91/813) 14.0 (109/779) HR (95% CI) HR (95% CI) 10 Principal Safety Outcome: Comparable rates of the composite of major bleeding and clinically relevant nonmajor bleeding across treatment groups 3 9.4% (388/4130) for versus 10.0% (412/4116) for (HR [95% CI]: 0.93 [ ]) 3 WARNINGS AND PRECAUTIONS (cont'd) Risk of Bleeding: increases the risk of bleeding and can cause serious or fatal bleeding. Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Discontinue in patients with active pathological hemorrhage. A specific antidote for rivaroxaban is not available. Because of high plasma protein binding, rivaroxaban is not expected to be dialyzable. Concomitant use of other drugs affecting hemostasis increases the risk of bleeding. These include aspirin, P2Y 12 platelet inhibitors, other antithrombotic agents, fibrinolytic therapy, and NSAIDs. INR = international normalized ratio. * Bleeding event occurred after randomization and up to 2 days after the last dose of study drug. Although a patient may have had 2 or more events, the patient is counted only once in a category. Treatment schedule in EINSTEIN DVT and EINSTEIN PE studies: 15 mg twice daily for 3 weeks followed by 20 mg once daily; / warfarin (: 1 mg/kg twice daily, warfarin: individually titrated doses to achieve a target INR of 2.5 [range: ]). Major bleeding was defi ned as overt bleeding associated with a fall in hemoglobin of 2 g/dl or more, leading to a transfusion of 2 or more units of packed red blood cells or whole blood, or that occurred in a critical site (intracranial, intraspinal, intraocular, pericardial, intra-articular, intramuscular with compartment syndrome, retroperitoneal), or contributing to death. 4 P= Not adjusted for multiplicity. II Fragility was defined as one or more of the following: age >75 years, CrCl <50 ml/min, or body weight 50 kg. For major bleeding, the P value for the treatment group fragility interaction was 0.011, suggesting heterogeneity. # Clinically relevant nonmajor bleeding was defi ned as overt bleeding not meeting the criteria for a major bleeding event but associated with medical intervention, unscheduled contact (visit or telephone call) with a physician, (temporary) cessation of study treatment, discomfort for the subject such as pain, or impairment of activities of daily life. 4 Arrows indicate statistical difference between and standard of care. 4 5

4 EINSTEIN DVT AND EINSTEIN PE TRIALS: CLINICAL OUTCOMES THERAPY MANAGEMENT Pooled Subgroup Analysis: Outcomes in Patients With Cancer 5 Single-Agent Anticoagulation Strategy From the Moment of Diagnosis Through the End of Treatment Clinical endpoint Recurrent VTE Major bleeding Clinically relevant bleeding Mortality Hazard Ratio (95% CI) 0.67 ( ) 0.42 ( ) 0.80 ( ) 0.93 ( ) N=651 patients vs 4.5 (16/354) 2.3 (8/353) 13.6 (48/353) 4.5 (16/353) PERCENT 6.6 (20/301) 5.0 (15/298) 16.4 (49/298) 5.4 (16/298) Treatment of DVT and PE Reduce risk of recurrent DVT and PE Tablets shown not actual size. 15 mg TWICE DAILY with food for first 21 days ON DAY 22 TRANSITION TO 20 mg ONCE DAILY 20 mg ONCE DAILY with food, at approximately the same time each day for remaining treatment with food, at approximately the same time each day Renal dosing considerations DVT and PE and reduction in risk of recurrence: Avoid using in patients with CrCl <30 ml/min HR (95% CI) 10 Patients with active cancer at baseline: 462 Patients with active cancer diagnosed during study: 193 Patients with recurrent or metastic cancer: 19% (49/258), 25% (52/204) with active cancer at baseline; 19% (18/96), 26% (25/97) with active cancer diagnosed during the study 5 Patients on chemotherapy: XARELTO 25% (88/354), 27% (81/301) with active cancer at baseline or active cancer diagnosed during the study 5 WARNINGS AND PRECAUTIONS (cont d) Spinal/Epidural Anesthesia or Puncture: When neuraxial anesthesia (spinal/epidural anesthesia) or spinal puncture is employed, patients treated with anticoagulant agents for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. To reduce the potential risk of bleeding associated with the concurrent use of rivaroxaban and epidural or spinal anesthesia/analgesia or spinal puncture, consider the pharmacokinetic profile of rivaroxaban. Placement or removal of an epidural catheter or lumbar puncture is best performed when the anticoagulant effect of rivaroxaban is low; however, the exact timing to reach a sufficiently low anticoagulant effect in each patient is not known. An epidural catheter should not be removed earlier than 18 hours after the last administration of. The next dose is not to be administered earlier than 6 hours after the removal of the catheter. If traumatic puncture occurs, the administration of is to be delayed for 24 hours. Should the physician decide to administer anticoagulation in the context of epidural or spinal anesthesia/analgesia or lumbar puncture, monitor frequently to detect any signs or symptoms of neurological impairment, such as midline back pain, sensory and motor deficits (numbness, tingling, or weakness in lower limbs), or bowel and/ or bladder dysfunction. Instruct patients to immediately report if they experience any of the above signs or symptoms. If signs or symptoms of spinal hematoma are suspected, initiate urgent diagnosis and treatment including consideration for spinal cord decompression even though such treatment may not prevent or reverse neurological sequelae. 6 7

5 LIFT HERE TO OPEN THERAPY MANAGEMENT THERAPY MANAGEMENT Switching Patients to and From SWITCHING TO XARELTO Starter Pack for initiation of DVT and/or PE Treatment XARELTO Starter Pack first 30 days for DVT and/or PE treatment From warfarin Stop warfarin and start when INR is <3.0 From unfractionated heparin From other anticoagulants Stop the infusion and start at the same time Start 0 to 2 hours prior to the next scheduled evening administration of the other anticoagulant (rivaroxaban) Tablets NDC Rx only Please see full Prescribing Information, including BOXED WARNINGS, and Medication Guide inside. Starter Pack for treatment of deep vein thrombosis and treatment of pulmonary embolism SWITCHING FROM Days 1-21 Days mg per tablet, twice daily 20 mg per tablet, once daily To warfarin * One approach is to stop and start parenteral anticoagulant and warfarin at time of next scheduled dose 42 tablets 9 tablets First 30-day supply To other anticoagulants BLEED MANAGEMENT Stop and start other anticoagulant when the next dose of would have been given * No clinical trial data are available to guide converting patients from to warfarin. affects INR, so INR measurements made during coadministration with warfarin may not be useful for determining the appropriate dose of warfarin. Oral or parenteral rapid-onset anticoagulants. Bleed Management When Using Promptly evaluate any signs and symptoms of blood loss and consider the need for blood replacement Discontinue in patients with active pathological hemorrhage Partial reversal of prothrombin time prolongation has been seen after administration of prothrombin complex concentrates (PCCs) in healthy volunteers The use of other procoagulant reversal agents like activated prothrombin complex concentrates (APCCs) or recombinant factor VIIa (rfviia) has not been evaluated This is not intended to replace clinical judgment or determine individual patient care. Provides therapy for the first 30 days when patients are most vulnerable to a recurrent event 6 Helps provide a seamless transition of care from diagnosis to follow- up The only pack available for initiation of DVT/PE treatment WARNINGS AND PRECAUTIONS (cont d) Use in Patients With Renal Impairment: Nonvalvular Atrial Fibrillation: Avoid the use of in patients with creatinine clearance (CrCl) <15 ml/min, since drug exposure is increased. Discontinue in patients who develop acute renal failure while on. Treatment of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Reduction in the Risk of Recurrence of DVT and of PE: Avoid the use of in patients with CrCl <30 ml/min due to an expected increase in rivaroxaban exposure and pharmacodynamic effects in this patient population. Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: Avoid the use of in patients with CrCl <30 ml/min due to an expected increase in rivaroxaban exposure and pharmacodynamic effects in this patient population. Observe closely and promptly evaluate any signs or symptoms of blood loss in patients with CrCl 30 to 50 ml/min. Patients who develop acute renal failure while on should discontinue the treatment. Use in Patients With Hepatic Impairment: No clinical data are available for patients with severe hepatic impairment. Avoid use of in patients with moderate (Child-Pugh B) and severe (Child-Pugh C) hepatic impairment or with any hepatic disease associated with coagulopathy, since drug exposure and bleeding risk may be increased. Use With P-gp and Strong CYP3A4 Inhibitors or Inducers: Avoid concomitant use of with combined P-gp and strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, lopinavir/ritonavir, ritonavir, indinavir/ritonavir, and conivaptan). Avoid concomitant use of with drugs that are P-gp and strong CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, St. John s wort). 8 9

6 THERAPY MANAGEMENT THERAPY MANAGEMENT CarePath Offers Services and Support for Your Patients at Every Step The CarePath Trial Offer Up to a free 30-day supply Eligible patients with an approved chronic indication for (15 mg or 20 mg) Subject to 1 use or 12 months from program start date, whichever comes first The CarePath Savings Card No cost for 12 months Eligible patients with an approved chronic indication for (15 mg or 20 mg)* Patients with commercial insurance receive 12 months at no cost* Continuing support may also be available for eligible patients who have exhausted their 12 months in the program * Per calendar year, subject to a $3,400 maximum annual program benefit. No monthly cap. Not valid for patients enrolled in Medicare Part D or Medicaid. For eligibility requirements and restrictions, visit XareltoCarePath.com or call XARELTO ( ). TRIAL OFFER BIN: GROUP: MEMBER: Please see the enclosed full Prescribing Information, including Boxed Warnings and Medication Guide, for (rivaroxaban) and discuss any questions you have with your doctor. SAVINGS CARD BIN: GROUP: XARELTO01 MEMBER: Please see the accompanying full Prescribing Information, including Boxed Warnings and Medication Guide, for and discuss any questions you have with your doctor. SEE REVERSE ACTIVATE CARD BEFORE USE RESTRICTIONS APPLY SEE REVERSE ACTIVATE CARD BEFORE USE RESTRICTIONS APPLY WARNINGS AND PRECAUTIONS (cont d) Risk of Pregnancy-Related Hemorrhage: In pregnant women, should be used only if the potential benefit justifies the potential risk to the mother and fetus. dosing in pregnancy has not been studied. The anticoagulant effect of cannot be monitored with standard laboratory testing and is not readily reversed. Promptly evaluate any signs or symptoms suggesting blood loss (eg, a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress). Supported by A comprehensive support program offering access, education, and adherence tools to help your patients start and stay on therapy. For more information about, CarePath, and all of its associated programs, visit: WARNINGS AND PRECAUTIONS (cont d) Patients With Prosthetic Heart Valves: The safety and efficacy of have not been studied in patients with prosthetic heart valves. Therefore, use of is not recommended in these patients. Acute PE in Hemodynamically Unstable Patients/Patients Who Require Thrombolysis or Pulmonary Embolectomy: Initiation of is not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy. DRUG INTERACTIONS Avoid concomitant use of with other anticoagulants due to increased bleeding risk, unless benefit outweighs risk. Promptly evaluate any signs or symptoms of blood loss if patients are treated concomitantly with aspirin, other platelet aggregation inhibitors, or NSAIDs. should not be used in patients with CrCl 15 to 80 ml/min who are receiving concomitant combined P-gp and moderate CYP3A4 inhibitors unless the potential benefit justifies the potential risk. USE IN SPECIFIC POPULATIONS Pregnancy Category C: should be used during pregnancy only if the potential benefit justifies the potential risk to mother and fetus. There are no adequate or well-controlled studies of in pregnant women, and dosing for pregnant women has not been established. Use with caution in pregnant patients because of the potential for pregnancy-related hemorrhage and/or emergent delivery with an anticoagulant that is not readily reversible. The anticoagulant effect of cannot be reliably monitored with standard laboratory testing. Labor and Delivery: Safety and effectiveness of during labor and delivery have not been studied in clinical trials. Nursing Mothers: It is not known if rivaroxaban is excreted in human milk. Pediatric Use: Safety and effectiveness in pediatric patients have not been established. Females of Reproductive Potential: Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician

7 In Initial Treatment Trials, EINSTEIN Enrolled a Large and Diverse Patient Population These trials were conducted with different designs and evaluated different populations, so direct comparisons of their results cannot be made Total patients studied PE only Previous VTE Provoked VTE Unprovoked VTE Recent trauma or surgery EINSTEIN DVT and PE pooled *1-3, % Elderly % % DVT only % 65.5% Both DVT and PE % 8.8% Cancer at baseline % 2.7% Average 6-month pill count % % 16.2% % 10.1% % % apixaban AMPLIFY 8, % Excluded by protocol edoxaban Hokusai-VTE % % % % % % Did not specify % Did not specify dabigatran RE-COVER I and II pooled % % % % % % Did not specify % Did not specify Up to + Percentage of patients calculated by pooling total patients with noted characteristic in each trial. * In EINSTEIN PE, 46 patients with suspected PE were either not confirmed or not evaluable, but 6 of these patients had confirmed proximal DVT; in EINSTEIN DVT, 22 patients had both DVT and PE, 1 patient had PE only, and 43 patients were missing, not evaluable, or had no symptomatic DVT and no PE. In the case of 6 patients in the RE-COVER I and RE-COVER II studies, the diagnosis of VTE was made locally and was subsequently not confirmed by the central adjudication committee. Elderly patients were aged >75 years for the EINSTEIN and RE-COVER trial programs, and aged 75 years for the AMPLIFY and Hokusai-VTE trials. Patients defined with having head trauma, other major trauma or major surgery 1 month prior to randomization were excluded from the trial. OVERDOSAGE Discontinue and initiate appropriate therapy if bleeding complications associated with overdosage occur. A specific antidote for rivaroxaban is not available. The use of activated charcoal to reduce absorption in case of overdose may be considered. Due to the high plasma protein binding, rivaroxaban is not expected to be dialyzable. ADVERSE REACTIONS IN CLINICAL STUDIES The most common adverse reactions with were bleeding complications. References: 1. The EINSTEIN Investigators. Oral rivaroxaban for systemic venous thromboembolism. N Engl J Med. 2010;363(26): The EINSTEIN PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14): Prins MH, Lensing AWA, Bauersachs R, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN DVT and PE randomized studies. Thromb J. 2013;11(10):21. doi: / Protocol for: The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26): Prins MH, Lensing AWA, Brighton TA, et al. Oral rivaroxaban versus with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomized controlled trials. Lancet Haematol Oct;1(1):e37-e46. doi: /s (14) Published online September 28, Limone BL, Hernandez AV, Michalak D, Bookhart BK, Coleman CI. Timing of recurrent venous thromboembolism early after the index event: a meta-analysis of randomized controlled trials. Thromb Res. 2013;132(4): Data on file. Janssen Pharmaceuticals, Inc. Based on Clinical Study Report. 8. Agnelli G, Buller HR, Cohen A, et al, for the AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9): Supplementary Appendix to: Agnelli G, Buller HR, Cohen A, et al; for the AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9): Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369: Schulman S, Kearon C, Kakkar AK, et al; for the RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361(24): Schulman S, Kakkar AK, Goldhaber SZ, et al; for the RE-COVER II Trial Investigators. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129(7): Online supplement to: Schulman S, Kakkar AK, Goldhaber SZ, et al; for the RE-COVER II Trial Investigators. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129(7): CIRCULATIONAHA DC1/004450_supplemental_material.pdf. Accessed February 23, Eliquis [prescribing information]. Princeton, NJ: Bristol-Myers Squibb Company; Pradaxa [prescribing information]. Ridgefield, CT: Boehringer lngelheim Pharmaceuticals, Inc.; Savaysa [prescribing information]. Parsippany, NJ: Daiichi Sankyo, Inc.; Data on file. Janssen Pharmaceuticals, Inc. Based on IMS Health, NPA Weekly, January Data on file. Janssen Pharmaceuticals, Inc. Based on IMS Health Longitudinal Prescription Database (LRx), through September Patel MR, Mahaffey KW, Garg J, et al; and the ROCKET AF Steering Committee, for the ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10): Granger CB, Alexander JH, McMurray JJV, et al; for the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11): Connolly SJ, Ezekowitz MD, Yusuf S, et al; and the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12): Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23) (suppl 1):I9-I Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism [supplemental appendix]. N Engl J Med. 2013;369(15): pdf. Accessed February 24, Giugliano RP, Ruff CT, Braunwald E, et al; for the ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369(22): Source: IMS Health, Formulary Impact Analyzer, January 2015, all pay types, <30-day supply. Average calculated using approved patient paid amounts. 26. Data on file. Janssen Pharmaceuticals, Inc. Based on IMS Health, NPA Weekly, October

8 THE #1 PRESCRIBED NOVEL ORAL ANTICOAGULANT IN THE US* 17 AMONG NOVEL ORAL ANTICOAGULANTS: Most real-world experience: more than 2 million patients prescribed in the US. 18 Most safety data generated in clinical trials in patients 1-3,8, 10-13,16,19-24 studied with high risk of thrombotic events. Most affordable: the lowest average out-of-pocket cost. 25 Not intended to be a comparison of safety or efficacy outcomes. Cardiologists and Primary Care Physicians prescribe more than any other novel oral anticoagulant 26 * Among Factor Xa inhibitors and direct thrombin inhibitors. Based on the following: CHADS 2 scores 3-6 in ROCKET AF (N=12,402), ARISTOTLE (N=5502), ENGAGE-AF (N=~11,200), and RE-LY (N=5882); risk factors of DVT, PE, DVT/PE, cancer, elderly, previous VTE, provoked VTE, unprovoked VTE, and recent trauma or surgery in EINSTEIN pooled analysis (N=8281), AMPLIFY (N=5395), Hokusai-VTE (N=8240), and RE-COVER I and II (N=5107). CHADS 2 = congestive heart failure, hypertension, age 75 years, diabetes mellitus, prior stroke or transient ischemic attack; DVT = deep vein thrombosis; PE = pulmonary embolism; VTE = venous thromboembolism. is licensed from Bayer HealthCare AG, Leverkusen, Germany. Janssen Pharmaceuticals, Inc March Janssen Pharmaceuticals, Inc.

More information for patients and caregivers can be accessed at http://www.xarelto-us.com/.

More information for patients and caregivers can be accessed at http://www.xarelto-us.com/. Janssen Research & Development Submits Application to U.S. FDA for XARELTO (rivaroxaban) to Reduce Secondary Cardiovascular Events in Patients with Acute Coronary Syndrome RARITAN, DECEMBER 29, 2011 -

More information

News Release. Media contacts: Ernie Knewitz Tel: 908.927.2953 Mobile: 917.697.2318 eknewitz@its.jnj.com

News Release. Media contacts: Ernie Knewitz Tel: 908.927.2953 Mobile: 917.697.2318 eknewitz@its.jnj.com News Release Media contacts: Ernie Knewitz Tel: 908.927.2953 Mobile: 917.697.2318 eknewitz@its.jnj.com Shaun Mickus Phone: 908.927.2416 Mobile: 973.476.7144 smickus@its.jnj.com Investor contacts: Stan

More information

NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM

NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM Carol Lee, Pharm.D., Jessica C. Song, M.A., Pharm.D. INTRODUCTION For many years, warfarin

More information

Prescriber Guide. 20mg. 15mg. Simply Protecting More Patients. Simply Protecting More Patients

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

More information

DVT/PE Management with Rivaroxaban (Xarelto)

DVT/PE Management with Rivaroxaban (Xarelto) DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular

More information

Failure or significant adverse effects to all of the alternatives: Eliquis and Xarelto

Failure or significant adverse effects to all of the alternatives: Eliquis and Xarelto This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization

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

More information

Thrombosis and Hemostasis

Thrombosis and Hemostasis Thrombosis and Hemostasis Wendy Lim, MD, MSc, FRCPC Associate Professor, Department of Medicine McMaster University, Hamilton, ON Overview To review the important developments in venous thromboembolism

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization

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

More information

Rivaroxaban (Xarelto ) by

Rivaroxaban (Xarelto ) by Essentia Health Med Moment Short Video Tune-Up A brief overview of a new medication, or important new medication information Rivaroxaban (Xarelto ) by Richard Mullvain RPH BCPS (AQC) Current - August 2011

More information

Committee Approval Date: September 12, 2014 Next Review Date: September 2015

Committee 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 information

Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation

Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 29,

More information

Prior Authorization Guideline

Prior Authorization Guideline Guideline Guideline Name Formulary Xarelto (rivaroxaban) UnitedHealthcare Community & State Approval Date 0/0/203 Revision Date 8//204 Technician Note: CPS Approval Date: /5/20; CPS Revision Date: 8/20/204

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE June 22, 2015 SUBJECT EFFECTIVE DATE MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Anticoagulants Pharmacy Service Leesa M. Allen, Deputy Secretary Office of Medical

More information

4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71

4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71 Anticoagulation in the 21 st Century Adam Karpman, D.O. Saint Francis Medical Center/Oklahoma State University Medical Center Disclosures: None Atrial Fibrillation Most common arrhythmia in clinical practice.

More information

The Role of the Newer Anticoagulants

The Role of the Newer Anticoagulants The Role of the Newer Anticoagulants WARFARIN = Coumadin DAGIBATRAN = Pradaxa RIVAROXABAN = Xarelto APIXABAN = Eliquis INDICATION DABIGATRAN (Pradaxa) RIVAROXABAN (Xarelto) APIXABAN (Eliquis) Stroke prevention

More information

Experience matters: Practical management in your hospital

Experience matters: Practical management in your hospital Experience matters: Practical management in your hospital Dr AGG Turpie McMaster University, Hamilton, ON, Canada Disclosures AGG Turpie has acted as a consultant for Bayer HealthCare, Janssen, Sanofi-Aventis,

More information

Reference ID: 3676584

Reference ID: 3676584 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use XARELTO (rivaroxaban) safely and effectively. See full prescribing information for XARELTO. XARELTO

More information

Objectives. New and Emerging Anticoagulants. Objectives (continued) 2/18/2014. Development of New Anticoagulants

Objectives. New and Emerging Anticoagulants. Objectives (continued) 2/18/2014. Development of New Anticoagulants Objectives New and Emerging Anticoagulants Adraine Lyles, PharmD, BCPS Clinical Pharmacy Specialist VCU Medical Center Describe the pharmacology of the novel oral anticoagulants Discuss the clinical evidence

More information

Review of Non-VKA Oral AntiCoagulants (NOACs) and their use in Great Britain

Review of Non-VKA Oral AntiCoagulants (NOACs) and their use in Great Britain Review of Non-VKA Oral AntiCoagulants (NOACs) and their use in Great Britain Dr Alexander (Ander) Cohen Guy s and St Thomas Hospitals, King s College London, UK Pavia Spring Meeting 13 June 2014 Overview

More information

FDA Approved Oral Anticoagulants

FDA Approved Oral Anticoagulants FDA Approved Oral Anticoagulants Generic (Trade Name) Warfarin (Coumadin, Jantoven ) 1 FDA approved indication Prophylaxis and treatment of venous thromboembolism (VTE) Prophylaxis and treatment of thromboembolic

More information

Breadth of indications matters One drug for multiple indications

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

More information

ABOUT XARELTO CLINICAL STUDIES

ABOUT 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 information

Reference ID: 3817480

Reference ID: 3817480 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use XARELTO (rivaroxaban) safely and effectively. See full prescribing information for XARELTO. XARELTO

More information

TSOAC Initiation Checklist

TSOAC Initiation Checklist Task Establish appropriate dose based on anticoagulant selected, indication and patient factors such as renal function. Evaluate for medication interactions that may necessitate TSOAC dose adjustment.

More information

Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical

Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Center A.Fib affects 2.2 million Americans. The lifetime

More information

Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013

Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Family physician with Rivergrove Medical Clinic Practice in the north end since 1985 Medical Director of the Wellness

More information

The New Kids on the Block: Oral Anticoagulants

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

More information

The author has no disclosures

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

More information

xaban) Policy covered: Coverage of following criteria: the following those who meet the or Hip Xarelto is For those impacted by this policy.

xaban) 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 information

New Oral Anticoagulants. How safe are they outside the trials?

New Oral Anticoagulants. How safe are they outside the trials? New Oral Anticoagulants How safe are they outside the trials? Objectives The need for anticoagulant therapy Indications for anticoagulation Traditional anticoagulant therapies Properties of new oral anticoagulants

More information

Disclosure/Conflict of Interest

Disclosure/Conflict of Interest NEW ORAL ANTICOAGULANTS: WHAT EVERY PHARMACIST SHOULD KNOW LORI B. HORNSBY, PHARMD, BCPS ASSOCIATE CLINICAL PROFESSOR AUHSOP CLINICAL PHARMACIST MIDTOWN MEDICAL CENTER OUTPATIENT CLINIC COLUMBUS, GEORGIA

More information

How To Treat Aneuricaagulation

How 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 information

New Oral Anticoagulants

New Oral Anticoagulants New Oral Anticoagulants Tracy Minichiello, MD Associate Professor of Medicine Chief, San FranciscoVA Anticoagulation and Thrombosis Service Ansell, J. Hematology Copyright 2010 American Society of Hematology.

More information

XARELTO (rivaroxaban) tablets, for oral use

XARELTO (rivaroxaban) tablets, for oral use (rivaroxaban) tablets, for oral use Revised: 01/2015 028145-150120 Highlights of Prescribing Information These highlights do not include all the information needed to use (rivaroxaban) safely and effectively.

More information

Medication Policy Manual. Topic: Eliquis, apixaban Date of Origin: July 12, 2013. Committee Approval Date: July 11, 2014 Next Review Date: July 2015

Medication Policy Manual. Topic: Eliquis, apixaban Date of Origin: July 12, 2013. Committee Approval Date: July 11, 2014 Next Review Date: July 2015 Medication Policy Manual Policy No: dru313 Topic: Eliquis, apixaban Date of Origin: July 12, 2013 Committee Approval Date: July 11, 2014 Next Review Date: July 2015 Effective Date: August 1, 2014 IMPORTANT

More information

Management for Deep Vein Thrombosis and New Agents

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

More information

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

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

More information

Venous Thromboembolism: Long Term Anticoagulation. Dan Johnson, Pharm.D.

Venous Thromboembolism: Long Term Anticoagulation. Dan Johnson, Pharm.D. Venous Thromboembolism: Long Term Anticoagulation Dan Johnson, Pharm.D. Disclosures No financial relationships with products discussed Off-label use of drug therapy always discussed Objectives Review clinical

More information

New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther

New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis Mark Crowther 1 Disclosures Advisory Boards in last 24 months Pfizer, Alexion, Bayer, CSL Behring,

More information

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below

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

More information

2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS

2/17/2015 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 information

STROKE PREVENTION IN ATRIAL FIBRILLATION

STROKE PREVENTION IN ATRIAL FIBRILLATION STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients

More information

DABIGATRAN ETEXILATE TARGET Vitamin K epoxide reductase WARFARIN RIVAROXABAN APIXABAN

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)

More information

Novel Anticoagulation Agents DISCLOSURES. Objectives ATRIAL FIBRILLATION TRIALS. NOAC Comparison 6/12/2015

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

More information

Out with the Old and in with the New? Target Specific Anticoagulants for Atrial Fibrillation

Out with the Old and in with the New? Target Specific Anticoagulants for Atrial Fibrillation Out with the Old and in with the New? Target Specific Anticoagulants for Atrial Fibrillation Goal Statement Pharmacists and technicians will gain knowledge in the use of target specific oral anticoagulants

More information

Thursday, September 17, 2015 at 6:30 PM. Roux And Brew Seafood Steakhouse

Thursday, September 17, 2015 at 6:30 PM. Roux And Brew Seafood Steakhouse OUR GUEST SPEAKER WILL BE Scott Boniol, MD Medical Director, Christus Cancer Treatment Center Shreveport, LA Dr. Boniol is a paid speaker for Janssen Pharmaceuticals, Inc. Thursday, September 17, 215 at

More information

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 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 information

New Anticoagulants: When and Why Should I Use Them? Disclosures

New Anticoagulants: When and Why Should I Use Them? Disclosures Winship Cancer Institute of Emory University New Anticoagulants: When and Why Should I Use Them? Christine L. Kempton, MD, MSc Associate Professor of Pediatrics and Hematology and Medical Oncology Hemophilia

More information

Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia

Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Insertion, removal or presence of a catheter in selected sites can place a patient who is antithrombotic agent at risk for a local bleeding

More information

Anticoagulation in Atrial Fibrillation

Anticoagulation in Atrial Fibrillation Anticoagulation in Atrial Fibrillation Parag P. Patel, MD FACC Disclosures Eliquis Speakers Bureau 1 Clinical Scenario Ms. L is a 76F admitted to the stroke service with a dense right sided hemiparesis

More information

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

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

More information

TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation

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

More information

Eliquis. Policy. covered: Eliquis is. indicated to. reduce the. therapy. Eliquis is. superior to. of 32 to. Eliquis is AMPLIFY. nonfatal. physicians.

Eliquis. 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 information

XARELTO (rivaroxaban) tablets, for oral use

XARELTO (rivaroxaban) tablets, for oral use (rivaroxaban) tablets, for oral use Revised: 09/2015 038571-150812 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use (rivaroxaban) safely and effectively.

More information

CDEC FINAL RECOMMENDATION

CDEC FINAL RECOMMENDATION CDEC FINAL RECOMMENDATION RIVAROXABAN (Xarelto Bayer Inc.) New Indication: Pulmonary Embolism Note: The Canadian Drug Expert Committee (CDEC) previously reviewed rivaroxaban for the treatment of deep vein

More information

Xarelto (Rivaroxaban)

Xarelto (Rivaroxaban) Xarelto (Rivaroxaban) Hightly selective, reversible, direct oral FXa inhibitor Maxium concentratiion after 2 to 4 hrs High bioavailability(66%),increase with food ( suggest with food) 1/3 from renal excretion,

More information

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

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

More information

East Kent Prescribing Group

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

More information

2. Background This indication of rivaroxaban had not previously been considered by the PBAC.

2. Background This indication of rivaroxaban had not previously been considered by the PBAC. PUBLIC SUMMARY DOCUMENT Product: Rivaroxaban, tablets, 15mg and 20mg, Xarelto Sponsor: Bayer Australia Ltd Date of PBAC Consideration: March 2013 1. Purpose of Application The application requested the

More information

1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF

1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF Objectives Atrial Fibrillation and Prevention of Thrombotic Complications: Therapeutic Update Andrea C. Flores Pharm.D Pharmacy Resident at the Miami VA Healthcare System Review the epidemiology, pathophysiology

More information

How To Compare The New Oral Anticoagulants

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

More information

Reference ID: 3269742

Reference ID: 3269742 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use XARELTO (rivaroxaban) safely and effectively. See full prescribing information for XARELTO. XARELTO

More information

Anticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk

Anticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk Anticoagulation at the end of life Rhona Maclean Rhona.maclean@sth.nhs.uk Content Anticoagulant Therapies Indications for anticoagulation Venous thromboembolism (VTE) Atrial Fibrillation Mechnical Heart

More information

Dabigatran (Pradaxa) Guidelines

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

More information

Oral Anticoagulants: What s New?

Oral Anticoagulants: What s New? Oral Anticoagulants: What s New? Sallie Young, Pharm.D., BCPS (AQ-Cardiology) Clinical Pharmacy Specialist, Cardiology Penn State Hershey Medical Center syoung1@hmc.psu.edu August 2012 Oral Anticoagulant

More information

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 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 information

Comparison between New Oral Anticoagulants and Warfarin

Comparison 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 information

XARELTO (RIVAROXABAN) EDUCATIONAL PACK FOR 15MG AND 20MG DOSING

XARELTO (RIVAROXABAN) EDUCATIONAL PACK FOR 15MG AND 20MG DOSING XARELTO (RIVAROXABAN) EDUCATIONAL PACK FOR 15MG AND 20MG DOSING NOW UPDATED A N D I N C L U D E S A NEW INDICATION Prevention of stroke and systemic embolism in eligible adult patients with non-valvular

More information

rivaroxaban 15mg and 20mg film-coated tablets (Xarelto ) SMC No. (852/13) Bayer plc

rivaroxaban 15mg and 20mg film-coated tablets (Xarelto ) SMC No. (852/13) Bayer plc rivaroxaban 15mg and 20mg film-coated tablets (Xarelto ) SMC No. (852/13) Bayer plc 08 February 2013 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises

More information

COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS. TARGET AUDIENCE: All Canadian health care professionals.

COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS. TARGET AUDIENCE: All Canadian health care professionals. COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS AND PHYSICIANS TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVES: To provide a comparison of the new

More information

Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism

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

More information

Cardiovascular Disease

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

More information

The speakers have attested that their presentation will be free of all commercial bias toward a specific company and its products.

The speakers have attested that their presentation will be free of all commercial bias toward a specific company and its products. Update on New Anticoagulants (Apixaban, Dabigatran and Rivaroxaban) Patient Safety Daniel B. DiCola, MD and Paul Ament,, Pharm.D Excela Heath, Latrobe, PA Disclosures: Paul Ament discloses that he receives

More information

To provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.

To provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis. DEEP VEIN THROMBOSIS: TREATMENT TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.

More information

Gruppo di lavoro: Malattie Tromboemboliche

Gruppo di lavoro: Malattie Tromboemboliche Gruppo di lavoro: Malattie Tromboemboliche 2381 Soluble Recombinant Thrombomodulin Ameliorates Hematological Malignancy-Induced Disseminated Intravascular Coagulation More Promptly Than Conventional Anticoagulant

More information

The importance of adherence and persistence: The advantages of once-daily dosing

The importance of adherence and persistence: The advantages of once-daily dosing The importance of adherence and persistence: The advantages of once-daily dosing Craig I. Coleman, PharmD Professor, University of Connecticut School of Pharmacy Storrs, CT, USA Conflicts of interest Dr

More information

XARELTO (RIVAROXABAN) PRESCRIBER GUIDE

XARELTO (RIVAROXABAN) PRESCRIBER GUIDE XARELTO (RIVAROXABAN) PRESCRIBER GUIDE Prescribing information found on pages 16-17 This guide is to be used to support the appropriate use of Xarelto in the following indications: Prevention of stroke

More information

Cardiology Update 2014

Cardiology Update 2014 Cardiology Update 2014 Update on the Novel Oral Anticoagulants (NOACS) Raymond Kawasaki, MD AMG Cardiology December 6, 2014 Disclosures I have no disclosures relevant to this presentation Contents I. The

More information

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

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

More information

CDEC FINAL RECOMMENDATION

CDEC FINAL RECOMMENDATION CDEC FINAL RECOMMENDATION RIVAROXABAN (Xarelto Bayer Inc.) New Indication: Atrial Fibrillation, Stroke Prevention Recommendation: The Canadian Drug Expert Committee (CDEC) recommends that rivaroxaban be

More information

Rivaroxaban 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 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 information

New Anticoagulation Agents and Their Reversal Agents. Objectives. Background 12/21/2015

New Anticoagulation Agents and Their Reversal Agents. Objectives. Background 12/21/2015 New Anticoagulation Agents and Their Reversal Agents Jay Hazelcorn, Pharm.D. PGY-1 Pharmacy Resident Broward Health Medical Center Objectives Review the pharmacology, indications, and place in therapy

More information

rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC

rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC 13 January 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS

More information

Bayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention

Bayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Long-term prevention of venous blood clots (VTE): Bayer Initiates Rivaroxaban

More information

Novel Oral Anticoagulants (NOACs) Prescriber Update 2013

Novel Oral Anticoagulants (NOACs) Prescriber Update 2013 Novel Oral Anticoagulants (NOACs) Prescriber Update 2013 Indications/Contraindications Indications Orthopedic VTE Prophylaxis VTE Treatment Stroke Prevention for non-valvular AF Contraindications 150 mg

More information

Traditional anticoagulants

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

More information

DOACs. What s in a name? or TSOACs. Blood Clot. Darra Cover, Pharm D. Clot Formation DOACs work here. Direct Oral AntiCoagulant

DOACs. What s in a name? or TSOACs. Blood Clot. Darra Cover, Pharm D. Clot Formation DOACs work here. Direct Oral AntiCoagulant DOACs NOACs or TSOACs Generic Name DOACs Brand Name Mechanism of Action Direct Xa Inhibitor Direct Thrombin Inhibitor Dabigatran Pradaxa X Rivaroxaban Xarelto X Darra Cover, Pharm D Apixaban Eliquis X

More information

Implementation of NICE TAs 261 and 287

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

More information

New Anticoagulants: What to Use What to Avoid

New 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 information

Rivaroxaban (Xarelto) in the management of stroke and DVT

Rivaroxaban (Xarelto) in the management of stroke and DVT Rivaroxaban (Xarelto) in the management of stroke and DVT Steve Chaplin MSc, MRPharmS, Victoria Haunton BM, DGM, MRCP, Thompson Robinson BMedSci, MD, FRCP and Catherine Bagot MD, FRCPath KEY POINTS is

More information

Uncontrolled when printed. Version 1.1. Acute Sector. Lead Author/Co-ordinator: Mr Simon Barker Consultant Orthopaedic Surgeon Julie Fraser

Uncontrolled when printed. Version 1.1. Acute Sector. Lead Author/Co-ordinator: Mr Simon Barker Consultant Orthopaedic Surgeon Julie Fraser Acute Sector NHS Grampian Staff Local Treatment Protocol For Venous Thromoboembolic Prophylaxis Using Rivaroxaban 10mg Tablets In Adult Patients Undergoing Elective Hip Or Knee Replacement Surgery. Lead

More information

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:

More information

Antiplatelet and Antithrombotics From clinical trials to guidelines

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

More information

NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl

NnEeWw 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 information

THE 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 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 information

Investor News. Phase III J-ROCKET AF Study of Bayer s Xarelto (rivaroxaban) Meets Primary Endpoint. Not intended for U.S.

Investor News. Phase III J-ROCKET AF Study of Bayer s Xarelto (rivaroxaban) Meets Primary Endpoint. Not intended for U.S. Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Phase III J-ROCKET AF Study of Bayer s Xarelto (rivaroxaban) Meets Primary Endpoint

More information

Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:

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

More information