How To Understand How The Brain Can Be Affected By Cardiac Problems
|
|
- Aron Simmons
- 3 years ago
- Views:
Transcription
1 Workshop 2e: Atrial Fibrillation, Heads and Hearts how the brain can be affected by cardiac problems Matthew Walters
2 Heads and Hearts Cardiac disease and stroke Matthew Walters University of Glasgow
3 Why discuss stroke? # 1 cause of disability # 3 cause of death (12%) 130,000 per year in UK Approx 3 billion direct NHS costs annually 7% NHS beds Reverse the historical perception of stroke
4
5 What I ll cover 5 Some historical perspective The burden of stroke attributable to heart rhythm problems, particularly Atrial Fibrillation (AF) Some new developments in the last few years
6 Disclosures I m the lead stroke consultant in north Glasgow I am involved in medicines regulation and rational prescribing I work in the Stroke Unit of the Western Infirmary in Glasgow 6 So I know about providing healthcare on a low budget
7 Historical perspective: Hippocrates The reason of an apoplexy..is stagnation or station of the blood, whereby all motion and action of the spirits is taken away... And that its motion is stop'd by sharp humours, or a plethora, or an afflux of cold humours On regimen in acute diseases, 400BC
8 AF and stroke To this variety of apoplexy those are most liable whose face and hands are constantly livid and whose pulse constantly unequal. Wepfer, 1658
9 What is AF?
10 What causes AF? There s a long list! High blood pressure Heart attacks or other heart disease Other sudden illnesses In about 1 in 10 cases no cause is found
11 Why is AF important? It can cause symptoms Palpitations Breathlessness Dizziness Chest pain It can cause stroke
12 Chimowitz. Stroke 1993; 24: 1015 Zabalgoitia. J Am Coll Cardiol 1998; 31: 1622 Atrial fibrillation causes stroke Left atrial appendage thrombus
13 U.S. Population (x 1000) AF Population (x 10) Age Distribution of People With AF 30,000 20,000 U.S. Population Population with Atrial Fibrillation 10% of people over 75 in the UK have AF , Arch Int Med. 1995;155:471. Age, years
14 Thromboembolic events Control patients in AF trials Cerebral 49 (91%) AF is associated with a 5-fold increase in stroke risk Systemic 5 (9%)
15 Severity of ischaemic stroke in AF Severity of events in 1,092 control patients Moderate to severe: 23 (45%) Fatal: 5 (10%) Mild: 23 (45%)
16 Summary so far AF is common AF causes lots of strokes These strokes are generally severe ones How can we prevent them?
17 Oral Anticoagulants historical Spoiled sweet clover Dicoumarol discovered development Warfarin clinical use Warfarin / Vitamin K mechanism Dabigatran Rivaroxaban Apixaban High / low dose AZD0837 Warfarin / INR Ximelagatran clinical trials Warfarin clinical trials s 1970s s 1990s Heparin discovered Heparin clinical use Continous heparin infusion/ aptt LMWH discovered LMWH clinical trials Pentasaccharide clinical trials Injection
18 History Haemorrhagic disease of cattle in1920s Reduction in plasma prothrombin Traced to sweet clover Active agent structurally similar to vitamin K 1939 agent isolated (dicumarol) at University of Wisconsin (Wisconsin Alumni Research Foundation)
19 Historical context Pesticide (avoided the bait shy problem) Unsuccessful suicide attempt (>300mg)1951 Dwight Eisenhower 1956
20 Efficacy of warfarin Compared with Control in Five Studies No. of Events Patientyears AFASAK If we BAATAF treat patients with warfarin for 1 year CAFA we ll 14 prevent 478 about 30 strokes SPAF SPINAF Combined* *Total risk reduction for all 5 studies combined is 68% Risk Reduction, % Warfarin Better Warfarin Worse
21 Patients assigned to warfarin in AF trials Intensity of Anticoagulation When Stroke Occurred INR Ratio AFASAK CAFA SPAF I BAATAF SPINAF PT Ratio (ISI 2.4) ACCP recommendation: INR: Target range for individual study
22 Problems with warfarin in AF Although cheap and effective Doubles risk of bleeding Needs monitoring Food / drug interactions Until recently these factors weren t important due to paucity of alternatives...
23 Efficacy of aspirin vs control No. of Events Patientyears Risk Reduction (%) AFASAK Aspirin is far less effective at stroke SPAF prevention in people with AF EAFT Combined * Aspirin Better Aspirin Worse *Total risk reduction for all 3 studies combined is 21%
24 INR Clinic 2011
25 Warfarin Use in Eligible Patients (%) Warfarin for atrial fibrillation Limitations lead to under-treatment % 61% 57% 55% Overall Use 40 44% 35% 20 0 < Age (years) Go A et al. Ann Intern Med 1999;131:927.
26 Warfarin for AF Limitations lead to inadequate treatment Adequacy of Anticoagulation in Patients with AF in Primary Care Practice No warfarin 65% INR above target 6% INR in target range 15% Samsa GP, et al. Arch Intern Med 2000;160:967. Subtherapeutic INR 13%
27 Economic burden of AF and stroke The American Heart Association estimates that the direct and indirect cost of stroke in the US is $65.5 billion 1 A German Registry has shown that the overall first-year cost of AF is 18,517 2 A 15% reduction in stroke-related hospital admissions in the UK would save an estimated 30 million/year 3 1. Rosamond W et al. Circulation. 2008;117:e25 146; 2. Kolominsky-Rabas PL et al. Stroke. 2006;37: ; 3. Stewart S et al. Heart. 2004;90:
28 Summary so far AF causes lots of strokes These strokes are generally severe ones The cost of stroke to the NHS and society is huge Warfarin is effective at preventing stroke in AF but It needs to be closely monitored This is easier said than done What are the alternatives?
29 Phase III AF Trials Re-LY ROCKET- AF ARISTO TLE ENGAGE AF-TIMI 48 Drug Dabigatran Rivaroxaban Apixaban Edoxaban Dose (mg) 150, (15*) 5 (2.5*) 60*, 30* Freq BID QD BID QD N 18,113 14,266 18,206 >21,000 Design PROBE 2x blind 2x blind 2x blind AF criteria AF x 1 < 6 mths AF x 2 (>1 in <30d) AF or AFl x 2 <12 mths AF x 1 < 12 mths % VKA naive 50% 38% 43% 40% goal *Dose adjusted in patients with drug clearance. **Max of 10% with CHADS-2 score = 2 and no stroke/tia/see PROBE = prospective, randomized, open-label, blinded end point evaluation VKA = Vitamin K antagonist
30 Summary of NOAC trials Class Effects: All three novel anticoagulants are non-inferior to warfarin in reducing the risk of stroke and systemic embolisation. All three agents reduce the risk of bleeding (fatal for Rivaroxaban, major for Apixaban, major at 110 mg for Dabigatran) and intracranial hemorrhage. The directionality and magnitude of the mortality reduction is consistent and approximates a RRR of 10% / year Differentiators: Dabigatran at a dose of 150 mg was associated with a reduction in ischaemic stroke Rivaroxaban is a once a day drug associated with a lower rate of fatal bleeding, and is taken once daily Apixaban was associated with a reduction in all cause but not CV mortality
31 Can we afford them? NOACS likely to be cost effective for patients at high risk (CHADS 2 >3) If CHADS 2 score of 3, ICER is under 20k If your warfarin clinic achieves excellent control (TTR > 65%) that figure will rise, and vice versa
32 Summary Paradigm shift in management of SPAF Use is progressively increasing as familiarity grows Economic models justify their use in specific circumstances Poor compliance, patient preference, geographic and social factors play a part in the decision We can t model these yet!
33
34 The 3 Ps and natural history of atrial fibrillation Paroxysmal Self-Terminating Persistent Lasts > 7 Days Permanent Cardioversion Failed or Not Attempted Normal Sinus Rhythm Atrial Fibrillation Paroxysmal AF is as likely to cause stroke as persistent or permanent AF
35 Even when it s prescribed... TTR in clinical trials? 60-70% TTR in real life? 50% (in most studies, but some claim more)
Current and new oral Anti-coagulation. Lancashire and Cumbria Network 2 February 2012
Current and new oral Anti-coagulation Lancashire and Cumbria Network 2 February 2012 Question Warfarin is an abbreviation What does the W stand for? What is this plant and what is the connection with warfarin?
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 informationNew Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013
New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7
More 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 information9/5/14. Objectives. Atrial Fibrillation (AF)
Novel Anticoagulation for Prevention of Stroke in Patients with Atrial Fibrillation Objectives 1. Review current evidence on use of warfarin in individuals with atrial fibrillation 2. Compare the three
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
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 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 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 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 informationNOAC S For Stroke Prevention in. Atrial Fibrillation. Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health
NOAC S For Stroke Prevention in Atrial Fibrillation Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health New Oral Anti Coagulant Formal Definition: Atrial Fibrillation
More informationAtrial Fibrillation and Anticoagulants
York Teaching Hospital NHS Foundation Trust Atrial Fibrillation and Anticoagulants A guide to your diagnosis and treatment Information for patients, relatives and carers For more information, please contact:
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 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 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 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 informationPrevention of thrombo - embolic complications
Update on atrial fibrillation Prevention of thrombo - embolic complications Felicita Andreotti Dept of Cardiovascular Science Catholic University, Rome, IT Consultant or speaker in past 2 years for Amgen,
More informationNew in Atrial Fibrillation
New in Atrial Fibrillation September 2011 Stroke prevention more options Rhythm Control -drugs - alternatives to drugs; ablation Rate Control - pace + ablate A-FIB Dell Stroke Risk AFib Two Principles
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 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 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 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 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 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 informationAdherence to NOACs. Disclosure. Patricia van den Bemt EAHP Hamburg 2015
Adherence to NOACs Patricia van den Bemt EAHP Hamburg 2015 Disclosure Unrestricted research grants from Glaxo-SmithKline Boehringer Ingelheim Daiichi Sankyo Bayer Pfizer For research on medication safety
More informationReview 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 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 informationAtrial Fibrillation: New Therapies for an Old Problem
Atrial Fibrillation: New Therapies for an Old Problem Nguyen Park, MS, PA-C UNM Physician Assistant Program Dept. of Family & Community Medicine Univesity of New Mexico Lead Clinician Special Environmental
More informationA Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation
Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE What is atrial fibrillation? Atrial fibrillation
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 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 informationHot Line Session at European Society of Cardiology (ESC) Congress 2014:
Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Hot Line Session at European Society of Cardiology (ESC) Congress 2014: Once-Daily
More informationExecutive Summary. Motive for the request for advice
Executive Summary Motive for the request for advice Currently nearly 400,000 people in the Netherlands are being treated with anticoagulants of a type Vitamin K antagonists (VKAs). Although VKAs are very
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 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 informationAnticoagulation 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 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 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 information3/3/2015. Patrick Cobb, MD, FACP March 2015
Patrick Cobb, MD, FACP March 2015 I, Patrick Cobb, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict
More 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 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 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 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 informationAtrial Fibrillation An update on diagnosis and management
Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.
More informationV1: Draft Nov 2014. Making decisions... about anticoagulation for stroke prevention in atrial fibrillation. www.weahsn.net
V1: Draft Nov 2014 Making decisions... about anticoagulation for stroke prevention in atrial fibrillation www.weahsn.net is this pack for? pack and booklet is for people with AF. It is designed to help
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 informationTA 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 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 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 informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
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 informationNICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation 1
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 informationXabans Good for What Ails Ya? Brian Tiffany, MD, PhD, FACEP Dept of Emergency Medicine Chandler Regional Medical Center Mercy Gilbert Medical Center
Xabans Good for What Ails Ya? Brian Tiffany, MD, PhD, FACEP Dept of Emergency Medicine Chandler Regional Medical Center Mercy Gilbert Medical Center DISCLOSURES No relevant financial disclosures I will
More informationNHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION
Version 3 August 2014 NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION Dorset CCG commissions the use of newer oral anti-coagulants in accordance
More informationGruppo 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 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 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 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 informationAnticoagulation for NVAF: NAOs or AVKs? Giancarlo Agnelli
Anticoagulation for NVAF: NAOs or AVKs? Giancarlo Agnelli Medicina Interna & Cardiovascolare - Stroke Unit Scuola di Specializzazione in Medicina di Emergenza - Urgenza Università di Perugia My talk today
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 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 informationTreating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
More informationDisclosure. New Agents for Treatment of DVT. Prevalence of DVT VTE. Normal Hemostasis 7/17/2015. Mark Oliver, MD, RVT, RPVI,FSVU
New Agents for Treatment of DVT Disclosure PI Adopt and Amplify trials Mark Oliver, MD, RVT, RPVI,FSVU BMS and Pfizer Speaker VTE Venous Thromboembolism Recognized DVT s New : 170,000 Recurrent : 90,000
More informationLimitations of VKA Therapy
Fibrillazione Atriale Non Valvolare Ischemia o Emorragia le Due Utopie Rivali nella Scelta dei NAO Gianluca Botto, MD, FESC, UO Elettrofisiologia, Dip Medicina Limitations of VKA Therapy Unpredictable
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 informationApixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation
Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation ERRATUM This report was commissioned by the NIHR HTA Programme as project number 11/49 This document
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 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 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 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 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 informationAtrial fibrillation: medicines to help reduce your risk of a stroke what are the options?
Patient decision aid Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options? http://guidance.nice.org.uk/cg180/patientdecisionaid/pdf/english Published: June 2014 About
More informationAtrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR
Atrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR Disclosures None relevant to this presentation Outline Introduction Natural History and Stroke Risk Stroke/Bleeding
More informationAcute behandeling van longembolie. Peter Verhamme. Bloedings- en Vaatziekten UZ Leuven. Research support and/or honoraria:
Acute behandeling van longembolie Peter Verhamme Bloedings- en Vaatziekten UZ Leuven Disclosures Research support and/or honoraria: Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Pfizer, BMS, Sanofi, Leo-pharma
More informationNew Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis
New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET Departments of Gastroenterology and Hepatology,
More informationAnticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions
Anticoagulants for stroke prevention in atrial fibrillation Patient frequently asked questions What is atrial fibrillation?...2 What are dabigatran, rivaroxaban and apixaban and what are they used for?...2
More informationTraditional anticoagulants
TEGH Family Practice Clinic Day April 4, 03 Use of Anticoagulants in 03: What s New (and What Isn t) Bill Geerts, MD, FRCPC Director, Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University
More informationAtrial Fibrillation (AF) Explained
James Paget University Hospitals NHS Foundation Trust Atrial Fibrillation (AF) Explained Patient Information Contents What are the symptoms of atrial fibrillation (AF)? 3 Normal heartbeat 4 How common
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 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 informationAtrial Fibrillation Peter Santucci, MD Revised May, 2008
Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial fibrillation (AF) is an irregular, disorganized rhythm characterized by a lack of organized mechanical atrial activity. The atrial rate is
More informationStroke Prevention in Atrial Fibrillation. NICE guidelines 2014 and their local implementation
Stroke Prevention in Atrial Fibrillation NICE guidelines 2014 and their local implementation Craig Barr Consultant Cardiologist Prescribing information available at this meeting L.GB.09.2014.7880c Date
More informationBios 6648: Design & conduct of clinical research
Bios 6648: Design & conduct of clinical research Section 1 - Specifying the study setting and objectives 1. Specifying the study setting and objectives 1.0 Background Where will we end up?: (a) The treatment
More informationSummary and general discussion
Chapter 7 Summary and general discussion Summary and general discussion In this thesis, treatment of vitamin K antagonist-associated bleed with prothrombin complex concentrate was addressed. In this we
More informationNOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST
NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST NGAIRE IS 70 YEARS OLD AND IN AF. SHE HAS NO MURMURS, NORMAL BLOOD PRESSURE, EGFR OF 65ML/MIN AND NO SIGNIFICANT PAST MEDICAL HISTORY. REGARDING
More informationNHS 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 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 informationBayer 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 informationThe New Anticoagulants are Here! Do you know how to use them? Arrhythmia Winter School February 11 th, 2012. Jeff Healey
The New Anticoagulants are Here! Do you know how to use them? Arrhythmia Winter School February 11 th, 2012 Jeff Healey RELY: A New Era in AF Connolly SJ et al. N Engl J Med 2009;361:1139-1151 ROCKET-AF:
More informationTreatments to Restore Normal Rhythm
Treatments to Restore Normal Rhythm In many instances when AF causes significant symptoms or is negatively impacting a patient's health, the major goal of treatment is to restore normal rhythm and prevent
More informationHow To Manage An Anticoagulant
PERI-OPERATIVE MANAGEMENT OF PATIENTS WHO ARE RECEIVING A NEW ORAL ANTICOAGULANT (DABIGATRAN, RIVAROXABAN, APIXABAN) TARGET AUDIENCE: All Canadian health care professionals, including primary care physicians,
More informationAtrial fibrillation (non-valvular) and reducing the risk of a stroke Management Options Brief Decision Aid
Atrial fibrillation (non-valvular) and reducing the risk of a stroke Management Options Brief Decision Aid Atrial fibrillation (AF) increases your risk of having a stroke (a blood clot in the brain). From
More informationNew Anticoagulants: What to Use What to Avoid
New Anticoagulants: What to Use What to Avoid Bruce Davidson, MD, MPH Clinical Professor of Medicine Pulmonary and Critical Care Medicine Division University of Washington School of Medicine Seattle USA
More informationNovel OACs: How should we use them?"
Novel OACs: How should we use them?" Iqwal Mangat, MD FRCPC" Director, Arrhythmia Service, St. Michaelʼs Hospital" Assistant Professor of Medicine, University of Toronto" Presenter Disclosure Dr. Iqwal
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 informationNICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues
NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues Andy Hutchinson Medicines Education Technical Adviser NICE Medicines and Prescribing Centre Note: this is
More informationGRASP-AF Coming to a PCT near you.
GRASP-AF Coming to a PCT near you. ADAS Anticoagulation dosing advisory service Blackpool Teaching Hospitals Trust Sean O'Brien; Anticoagulation Specialist BMS Grasp-AF and the implications on our Anticoagulation
More informationIntroduction. Background to this event. Raising awareness 09/11/2015
Introduction Primary Care Medicines Governance HSCB Background to this event New class of medicines Availability of training Increasing volume of prescriptions Reports of medication incidents Raising awareness
More information