ANTICOAGULATION USE FOR THE PREVENTION AND TREATMENT OF THROMBOEMBOLIC DISEASE
|
|
- Linette Harvey
- 8 years ago
- Views:
Transcription
1 ANTICOAGULATION USE FOR THE PREVENTION AND TREATMENT OF THROMBOEMBOLIC DISEASE Jamie N. Nadler, M.D. Assistant Professor of Medicine State University of New York at Buffalo Department of medicine Division of Pulmonary, Critical Care and Sleep Medicine
2 Abbreviations THA TKA HFS LMWH LDUH VKA GCS IPCD VFP IVC Total Hip Arthroplasty Total Knee Arthroplasty Hip Fracture Surgery Low molecular weight heparin Low dose unfractionated heparin Vitamin K Antagonist Graduated compression stockings Intermittent pneumatic compression device Venous foot pump Inferior Vena Cava
3 VTE PROPHYLAXIS Chest 2012;141;e278S-e325S Chest 2012;141;e195S-e226S
4 Medical Patients Pharmacologic Prophylaxis 2012 ACCP Acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with (): LMWH LDUH bid or tid fondaparinux For acutely ill hospitalized medical patients who are at low risk of thrombosis bleeding or at high risk for bleeding, we recommend against anticoagulant thromboprophylaxis (1B)
5 Medical Patients Mechanical Prophylaxis Recommended Risk Factor N (%) OR (CI) Active GD Ulcer 236 (2.2) 4.15 ( ) Bleeding 3 months PTA 231 (2.2) 3.64 ( ) Platelets < 50 K 170 (1.7) 3.37 ( ) Age > 85 yrs (vs 40yrs) 1178 (10.8) 2.96 ( ) Hepatic Failure (INR> 1.5) 219 (2) 2.18 ( ) Renal Failure (GFR < 30ml/min) 1084 (11) 2.14 ( ) ICU or CCU admission 923 (8.5) 2.10 ( ) CVC 820 (7.5) 1.85 ( ) Rheumatic Disease 740 (6.8) 1.78 ( ) Current Cancer 1166 (10.7) 1.78 ( ) Male Gender 5367 (49.4) 1.48 ( ) Decousus Chest 2011;139: ACCP For acutely ill hospitalized medical patients at increased risk of thrombosis Who are bleeding or at high risk for major bleeding, we suggest optimal use of mechanical thromboprophylaxis with GCS or IPC (2C) When bleeding risk decreases, and if VTE risk persists, we suggest pharmacologic thromboprophylaxis be substituted for mechanical thromboprophylaxis (2B)
6 Medical (Non-surgical)Patients Additional Recommendations Condition 2012 Cancer No specific recommendations for surgical or medical inpatients. High VTE risk outpatients with solid tumors and low bleeding risk suggest prophylactic LMWH or LDUH (2B) Critically Ill Recommendations similar to 2012 general medical patients Compression U/S NOT recommended Chronic Immobility Long Distance Travel Suggest against the routine use of thromboprophylaxis Flight > 6 hours and high risk suggest ambulation, hydration, GCS Pharmacologic therapy is NOT recommended Extended Px Suggest against the routine use of thromboprophylaxis beyond hospitalization (except in certain cancer patients)
7 Orthopedic Surgery Prophylaxis 2012 ACCP TKA, THA, use one of the following for a min 10 to 14 days: LMWH, Fondaparinux Adjusted-dose VKA LDUH Aspirin Apixaban, Dabigatran, Rivaroxaban (1B) IPCD (1C) Recommended agents for Hip Fracture Surgery LMWH is suggested as the preferred agent (2C) Duration of treatment of 35 days is suggested (2B) Combined Pharmacologic and IPCD is suggested (2C)
8 Orthopedic Surgery Prophylaxis High Bleeding Risk General Risk Factors for Bleeding Previous major bleeding Includes previous bleeding risk similar to current risk Severe renal failure Concomitant anti-platelet agent Surgical factors: History of difficult to control surgical bleeding Current operative procedure has difficult to control bleeding Extensive surgical dissection Revision surgery 2012 ACCP In patients undergoing major orthopedic surgery and increased risk of bleeding, we suggest: Using an IPCD or no prophylaxis (2C). AGAINST IVC filter placement for primary prevention in patients with an increased bleeding risk or contraindications to both pharmacologic and mechanical thromboprophylaxis (2C)
9 Orthopedic Surgery Utilization of new anticogulants In patients who decline or are uncooperative with injections or an IPCD, we recommend using oral therapy(1b): apixaban or dabigatran or rivaroxaban or adjusted-dose VKA (if above unavailable) Limitations of alternative agents compared with LMWH Fondaparinux, rivaroxaban, and VKA - Potential increased bleeding LDUH, VKA, aspirin, and IPCD alone - Possible decreased efficacy Apixaban, dabigatran, and rivaroxaban - Lack of long-term safety data
10 VTE TREATMENT Chest 2012;141;e419S-e494S
11 Duration of Therapy for Thromboembolic Disease Proximal DVT or Pulmonary Embolism Provoked Unprovoked By Surgery Non Surgical Transient Factor First Episode Second Episode Bleeding Risk 1B 1B 2B 1B 1B Provoked Requiring Treatment High Distal DVT Low/Mod 3 Months 2B Low/Mod 1B High Bleeding Risk Unprovoked High Low/Mod High Mod Low In all patients who receive extended anticoagulant therapy, the continuing use of treatment should be reassessed at periodic intervals 2B 1B 2B 1B 2B Low/Mod PE / DVT Extended 1B 2B High Bleeding Risk Unprovoked Pulmonary Embolism with Active Cancer
12 Initial Anticoagulant Treatment Acute DVT and Pulmonary Embolism Acute DVT Suggest LMWH or fondaparinux over IV or SC UFH (2C) Acute PE ACCP 2012 Suggest LMWH or fondaparinux over IV UHF(2C,2B) or SC UFH (2B,2C) IV UFH is preferred if absorption is questionable or if thrombolysis is being considered Recommend early initiation of VKA and continue For a minimum of 5 days and INR is 2.0 for at least 24 h (Grade 1B)
13 Extended Treatment Special Considerations DVT and Pulmonary Embolism Patients without cancer: ACCP 2012 VKA is suggested over LMWH (2C) If VKA not used LMWH is suggested over rivaroxaban (2C) Patients with cancer: LMWH is suggested over VKA (2B) VKA is suggested over rivaroxaban (2B DVT, 2C PE) Drug choice for extended treatment should be the same as the first 3 months
14 Extended Treatment Special Considerations DVT and Pulmonary Embolism Rivaroxaban (Xarelto) FDA approved for treatment of thromboembolic disease In studies found to be non-inferior to enoxaparin/warfarin in preventing recurrent DVT/PE Aspirin WARFASA study compared 100mg ASA vs. placebo Approximately 40% relative or 4.5% absolute reduction in recurrent VTE Not compared to standard of care - warfarin NEJM 2010;363; NEJM 2012;366: NEJM 2012;266:
15 Warfarin Therapy ACCP 2012 For patients sufficiently healthy to be treated as outpatients, we suggest initiating VKA therapy with warfarin 10 mg daily for the first 2 days followed by dosing based on INR measurements rather than starting with the estimated maintenance dose (2C) Consider 5mg Load in Inpatients Elderly Impaired nutrition Liver disease CHF High risk of bleeding Careful consideration with use of NSAIDS, Antimicrobials (SMX/TMP and quinolones) Concurrent anti-platelet agents should be reserved for situations where the benefit outweighs the risk of bleeding: ACS, Recent revascularization For patients taking VKA therapy with consistently stable INRs, we suggest an INR testing frequency of up to 12 weeks rather than every 4 weeks (2B)
16 PERIOPERATIVE MANAGEMENT Chest 2012;141;e326S-e350S
17 Surgical Procedures: VKA Recommendations High Risk of Bleeding Urologic surgery and procedures such as TURP, bladder resection, or tumor ablation; nephrectomy or kidney biopsy Pacemaker or implantable cardio- defibrillator device implantation Colonic polyp resection, typically of large (ie,1-2 cm long) sessile polyps Surgery and procedures in highly vascular organs, such as the kidney, liver, and spleen Bowel resection Major surgery with extensive tissue injury Cancer surgery, joint arthroplasty, reconstructive plastic surgery Cardiac, intracranial, or spinal surgery 1) Recommend stopping VKAs approximately 5 days before surgery (1C) 2) Recommend resuming VKAs approximately 12 to 24 h after surgery and when there is adequate hemostasis (2C) ACCP 2012 Low Risk Of Bleeding Minor dental procedure Including tooth extractions and endodontic procedures Continuing VKAs with coadministration of an oral prohemostatic agent OR Stop VKAs 2 to 3 days before the procedure Minor dermatologic procedures Including excision of basal and squamous cell skin cancers, actinic keratoses, and premalignant or cancerous skin nevi Cataract surgery Continue VKAs around the time of the procedure and optimizing local hemostasis Continue VKAs around the time of the surgery
18 Bridging Recommendations ACCP 2012 In patients with a mechanical heart valve, Afib, or VTE High risk for thromboembolism we suggest bridging Low risk for thromboembolism we suggest no-bridging Moderate risk for thromboembolism approach chosen is based on an assessment of individual patientand surgery-related factors
19 Risk Stratification for Perioperative VTE Risk VTE Mechanical Valves Atrial Fibrillation High Recent VTE (< 3 mo) Severe thrombophilia (eg, deficiency of proteins C or S, Antithrombin or antiphospholipid Abs multiple abnormalities) Any mitral valve Any caged-ball or tilting disc AVR Recent (within 6 mo) stroke or TIA CHADS 2 score 5 or 6 Recent (< 3 mo) stroke or TIA Rheumatic valvular heart disease Moderate VTE > 3 < 12 mo Recurrent VTE Active cancer (treated 6 mo/palliative) Nonsevere thrombophilia Bileaflet AVR and one or more risk factors: Afib, prior stroke or TIA, HTN, DM, CHF, age >75 y CHADS 2 score 3 or 4 (eg, heterozygous factor V Leiden or prothrombin gene mutation) Low VTE > 12 mo and no other risk factors Bileaflet AVR without Afib and no other risk factors for stroke CHADS 2 score 0 to 2 (assuming no prior stroke or TIA High-risk patients may also include those with 1. Prior TE during temporary interruption of VKAs 2. Surgery associated with an increased risk for stroke or other thromboembolism (eg, cardiac valve replacement, carotid endarterectomy, major vascular surgery) 3. Prior stroke or TIA occurring >3 mo before the planned surgery and a CHADS 2 score < 5,
20 Timing of Bridging Regimens Discontinuation of preoperative therapy Therapeutic-dose IV UFH should stop 4 to 6 h before surgery Therapeutic-dose SC LMWH, the last preoperative dose 24 h before surgery Resumption of postoperative therapy Regardless of bleeding risk the decision to resume therapeutic anticoagulation should be made after hemostasis has been achieved Resumption of bridging anticoagulation in patients undergoing high-bleeding-risk surgery, should be 48 to 72 h after surgery
21 Recommended Elements for Bridging Protocols 1. Assessing patients at least 7 days before surgery to allow planning of perioperative anticoagulant 2. Providing patients and providers with a calendar outlining: Perioperative timing of warfarin discontinuation and resumption Dose and timing of LMWH bridging INR measurement schedule 3. Ensuring that the perioperative management strategy accounts for the drugs pharmacokinetic profile and patients thromboembolic and bleeding risks 4. Patient/Caregiver education on injection technique 5. INR the day before surgery, where appropriate and feasible Identify patients with elevated INRs Permit timely use of corrective oral vitamin K ( mg), thereby avoiding blood product administration or surgery deferral 6. Assessing postoperative hemostasis, preferably on the day of surgery and on the first postoperative day Facilitate safe resumption of anticoagulant drugs
22 BLEEDING MANAGEMENT Chest 2012;141;e152S-e184S
23 Management of Elevated INRs ACCP 2012 INR 4.5 and 10 with no bleeding We suggest against the routine use of vitamin K (2B) INR> 10.0 with no bleeding We suggest that oral vitamin K be administered (2C). VKA-associated major bleeding We suggest rapid reversal of anticoagulation with four-factor prothrombin complex concentrate rather than with plasma. (2C). We suggest the additional use of vitamin K 5 to 10 mg administered by slow IV injection rather than reversal with coagulation factors alone (2C)
24 Management of Newer Anticoagulants Reversal Dabigatran Rivaroxaban Apixaban specific antidote None None None Vit K, FFP No No No Protamine No No No apcc, PCC??? Dialysis 60% removed No High protein binding No High protein binding
25
26
3/3/2015. 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 informationCHADS score of 5 or 6 Recent (within 3mo) stroke or TIA Rheumatic valvular heart disease CHADs score of 3 or 4
LAMC Department of Pharmacy Services: ANTICOAGULATION: Surgical Intervention Table 1: Classification of Surgical interventions according to bleeding risk t required to discontinue anticoagulation Dental
More information6/19/2012. Update on Venous Thromboembolism Prophylaxis. Disclosure. Learning Objectives. No conflicts of interest to declare
Update on Venous Thromboembolism Prophylaxis Disclosure No conflicts of interest to declare Learning Objectives After completion of this presentation, participants should be able to: Define venous thromboembolism,
More informationPublished 2011 by the American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL 60018. AAOS Clinical Practice Guidelines Unit
Volume 4. AAOS Clinical Guideline on Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty Comparison with Other Guidelines Disclaimer This clinical guideline
More informationTo Bridge or Not to Bridge. Periop Anticoagulation Management. Don Weinshenker, MD Ambulatory Care Denver VAMC
To Bridge or Not to Bridge Periop Anticoagulation Management Don Weinshenker, MD Ambulatory Care Denver VAMC Financial Disclosure Information Nothing to report Periop AC Management Chronically anti-coagulated
More informationThe Anticoagulated Patient A Hematologist s Perspective
The Anticoagulated Patient A Hematologist s Perspective Deborah M. Siegal MD MSc FRCPC Clinical Scholar Division of Hematology and Thromboembolism Thrombosis Canada Research Fellow McMaster University
More 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 informationDVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
More 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 informationClinical Practice Guideline for Anticoagulation Management
Clinical Practice Guideline for Anticoagulation Management This guideline is to inform practitioners of the Standard of Care for providing safe and effective anticoagulation management for ambulatory patients.
More informationUHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient
Guidelines for Anticoagulation Initiation and Management Y2014 UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient Topic Page Number MEDICATION FLOW AND PATIENT FLOW... 2 AND 3 PARENTERAL ANTICOAGULANTS...
More informationPerioperative Anticoagulation Management. Tony Ochoa, MD, FACC
Perioperative Anticoagulation Management Tony Ochoa, MD, FACC Interrupting Anticoagulation: To Bridge or Not? Peri-operative is most common reason Injury/Acute internal bleeding (not discussed) Atrial
More informationACCP CLINICAL RESOURCE
ACCP CLINICAL RESOURCE Facilitating Learning and Change in Clinical Care Antithrombotic Therapy and Prevention of Thrombosis 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice
More informationPrescriber 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 informationGREEN ZONE No action needed. You are doing great
Blood Thinner Safety Plan: Which zone are you in? Check your zone often to stay healthy and safe The name of my blood thinner is: (CIRCLE the medications you take): Coumadin (warfarin) Pradaxa (dabigatran)
More informationThe 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 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 informationNew 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 informationNHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS
NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS Date of First Issue 01/12/ 2012 Approved 15/11/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016
More 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 informationNew 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 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 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 informationAnticoagulation Dosing at UCDMC Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h
Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h See EMR adult VTE prophylaxis CI order set Enoxaparin See service specific dosing Assess
More informationComparison between New Oral Anticoagulants and Warfarin
Comparison between New Oral Anticoagulants and Warfarin Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. In recent years, several
More 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 informationReducing Adverse Drug Events With Anti Coagulation Clinics. McFarland Clinic. McFarland Protime Clinic 09/05/12
Reducing Adverse Drug Events With Anti Coagulation Clinics Dr. Donald Skinner, MD McFarland Clinic 182 Physicians (149 Shareholders) 40 Mid Level Providers 13 Administrators/Executive Directors 1,200 Support
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 information5/21/2012. Perioperative Use Issues. On admission: During hospitalization:
Dabigatran and Rivaroxaban: Challenges in the Perioperative Setting Claudia Swenson, Pharm.D., CDE, BC-ADM, FASHP Central Washington Hospital Wenatchee, WA claudia.swenson@cwhs.com Dabigatran and Rivaroxaban:
More informationVenous Thromboembolic Treatment Guidelines
Venous Thromboembolic Treatment Guidelines About the NYU Venous Thromboembolic Center (VTEC) The center s mission is to deliver advanced screening, detection, care, and management services for patients
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 informationFailure or significant adverse effects to all of the alternatives: Eliquis and Xarelto
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics
More informationTo 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 informationEast Kent Prescribing Group
East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal
More informationUpdate on Antiplatelets and anticoagulants. Outlines. Antiplatelets and Anticoagulants 1/23/2013. Timir Paul, MD, PhD
Update on Antiplatelets and anticoagulants Timir Paul, MD, PhD Antiplatelets Indications Doses Long term use (beyond 12 months) ASA and combination use of NSAIDS ASA resistance Plavix resistance Plavix
More 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 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 information2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2.
Anticoagulation dosing at UCDMC (SC=subcutaneously; CI=continuous infusion) Indication Agent Dose Comments Prophylaxis Any or No bleeding risk factors see adult heparin (VTE prophylaxis) IV infusion order
More 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 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 informationWhat Does Pregnancy Have to Do With Blood Clots in a Woman s Legs?
Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning A Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning Drugs to Prevent Abnormal Blood
More informationInpatient Anticoagulation Safety. To provide safe and effective anticoagulation therapy through a collaborative approach.
Inpatient Anticoagulation Safety Purpose: Policy: To provide safe and effective anticoagulation therapy through a collaborative approach. Upon the written order of a physician, Heparin, Low Molecular Weight
More informationSTARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach
STARTING, SWITCHING OR STOPPING NEW ORAL ANTICOAGULANTS: A Practical Approach Jeffrey I Weitz, MD, FRCP(C), FACP Professor of Medicine and Biochemistry McMaster University Canada Research Chair in Thrombosis
More information2/17/2015 ANTICOAGULATION UPDATE OBJECTIVES BRIEF REVIEW: CLASSES OF ORAL ANTICOAGULANTS
ANTICOAGULATION UPDATE C AR R I E P AL M E R, D N P, RN, AN P - BC OBJECTIVES At the end of the presentation, the NP will be able to: Identify new indications for target-specific oral anticoagulants (TSOACs),
More informationAdvanced Issues in Peri-Operative VTE Prevention
Advanced Issues in Peri-Operative VTE Prevention Michael-Anthony (M-A) Williams, M.D. Consultant Physician Centura Medical Consultants September 27th, 2012 Main Topics 1. The perils of the early mover-
More informationNHS FIFE WIDE POLICY - HAEMATOLOGY MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY
MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY The scope of this guideline is to simplify the management of patients on oral anticoagulation undergoing major and minor surgery.
More informationGUIDELINE FOR THE MANAGEMENT OF ORAL ANTICOAGULATION BEFORE AND AFTER ELECTIVE SURGERY OR PROCEDURES
GUIDELINE FOR THE MANAGEMENT OF ORAL ANTICOAGULATION BEFORE AND AFTER ELECTIVE SURGERY OR PROCEDURES OBJECTIVE The objective of this guideline is to optimize the quality of care for patients who require
More informationDirect Oral Anticoagulants (DOACs) Who Gets What?
Direct Oral Anticoagulants (DOACs) Who Gets What? Kathryn Hassell, MD Professor of Medicine, Division of Hematology University of Colorado Denver Disclosures No financial or commercial conflicts of interest
More information- Recent VTE (within 3 mo) - Severe thrombophilia: - CHADS 2 of 5 or 6 - Recent stroke or TIA (within 3 mo) - Rheumatic valvular heart disease
GUIDELINE for PERIOPERATIVE MANAGEMENT OF ANTITHROMBOTIC THERAPY This document is intended as a guideline only and should not replace sound clinical judgment Bridging therapy is a complex process that
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 informationANTICOAGULATION IN ATRIAL FIBRILLATION. Heather Kertland St Michael s Hospital University of Toronto
ANTICOAGULATION IN ATRIAL FIBRILLATION Heather Kertland St Michael s Hospital University of Toronto Susan A 73 year old female admitted to the general medicine ward with pneumonia. She had been feeling
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 informationTrust Guideline for Thromboprophylaxis in Trauma and Orthopaedic Inpatients
A clinical guideline recommended for use In: By: For: Key words: Department of Orthopaedics, NNUHT Medical staff Trauma & Orthopaedic Inpatients Deep vein thrombosis, Thromboprophylaxis, Orthopaedic Surgery
More informationSNAPSHOT OF ANTITHROMBOTIC THERAPY WITH A FOCUS
SNAPSHOT OF ANTITHROMBOTIC THERAPY WITH A FOCUS ON THE PERIOPERATIVE PERIOD A PHARMACIST S PERSPECTIVE Katie Cinnamon, PharmD, BCPS Clinical Pharmacist DISCLOSURE The content of this presentation is based
More informationLow Molecular Weight Heparin. All Wales Medicines Strategy Group (AWMSG) Recommendations and advice
Low Molecular Weight Heparin All Wales Medicines Strategy Group (AWMSG) Recommendations and advice Starting Point Low Molecular Weight Heparin (LMWH): Inhibits factor Xa and factor IIa (thrombin) Small
More informationThe 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 informationAnticoagulant therapy
Anticoagulation: The risks Anticoagulant therapy 1990 2002: 600 incidents reported 120 resulted in death of patient 92 deaths related to warfarin usage 28 reports related to heparin usage Incidents in
More informationFDA 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 informationAntithrombotic therapy
Orthogeriatrics Clinical Summary Document Antithrombotic therapy Topics Preexisting anticoagulation and timing of surgery Reversal of anticoagulation Perioperative thromboprophylaxis When should we be
More informationAnticoagulation and Reversal
Anticoagulation and Reversal John Howard, PharmD, BCPS Clinical Pharmacist Internal Medicine Affiliate Associate Clinical Professor South Carolina College of Pharmacy Disclosures I have no Financial, Industry,
More informationDabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM
Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM This report was commissioned by the NIHR HTA Programme as project number 12/78
More informationProgram Objectives. Why Use Anticoagulants? 6/5/2014
Larry Reis RPh CGP FASCP Prepared June 2014 for NADONA REIS RXCARE CONSULTING Reisrxcare@comcast.net 1 Program Objectives Discuss complications of current anticoagulant Rx Identify risks of using anticoagulants
More informationBridging anticoagulation: the peri-procedural management of patients on oral anticoagulants (excluding neurosurgery)
Barnsley Hospital NHS Foundation Trust Bridging anticoagulation: the peri-procedural management of patients on oral anticoagulants (excluding neurosurgery) Reproduced and Adapted from the Sheffield Bridging
More informationOral 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 informationSpeaker Disclosure. Outline. Pharmacist Objectives. Patient Case. Outline 9/4/2014
Speaker Disclosure Matthew K. Pitlick, Pharm.D., BCPS St. Louis College of Pharmacy/VA St. Louis HCS mpitlick@stlcop.edu Matthew K. Pitlick, Pharm.D., BCPS declares no conflicts of interest, real or apparent,
More informationPulmonary Embolism Treatment Update
UC SF Pulmonary Embolism Treatment Update Jeffrey Tabas, MD Professor UCSF School of Medicine Emergency Department San Francisco General Hospital sf g h Disclosure No Financial Relationships to Disclose
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 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 informationOutpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013
Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013 General Principles: There is compelling data in the medical literature to support
More information1/12/2016. What s in a name? What s in a name? NO.Anti-Coagulation. DOACs in clinical practice. Practical aspects of using
What s in a name? Practical aspects of using DOACs (Direct Oral Anticoagulants) James L. Sebastian, MD, MACP Professor of Medicine (GIM) Medical College of Wisconsin February 5, 2016 DOAC NOAC NOAC ODI
More 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 informationBreadth of indications matters One drug for multiple indications
Breadth of indications matters One drug for multiple indications Sylvia Haas, MD, PhD Formerly of the Technical University of Munich Munich, Germany Disclosures: Sylvia Haas 1 Novel oral anticoagulants:
More 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 informationBuilding a Safe Anticoagulation Program By knowing that Safety is not about numbers, Safety is about an attitude..
Building a Safe Anticoagulation Program By knowing that Safety is not about numbers, Safety is about an attitude.. Speakers: Sue Dawson, MA, RN, CCRP Clinical Specialist-Cardiology Cam F. Campbell, M.D.
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 informationNnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl
NnEeWw DdEeVvEeLlOoPpMmEeNnTtSs IiıNn OoRrAaLl AaNnTtIiıCcOoAaGgUuLlAaTtIiıOoNn AaNnDd RrEeVvEeRrSsAaLl Mikele Wissing, RN June 2014 Introduction until recently, was the unrivaled medication for treatment
More 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 informationUsing CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital
Using CDS (Clinical Decision Support) for Quality Initiatives at a Community Hospital Jonathan Sykes MD, CMIO Jacalyn Liebowitz RN, MBA,NEA-BCFACHE VP Care Continuum Allegiance Health - Jackson, MI DISCLAIMER:
More informationAppendix C Factors to consider when choosing between anticoagulant options and FAQs
Appendix C Factors to consider when choosing between anticoagulant options and FAQs Choice of anticoagulant for non-valvular* atrial fibrillation: Clinical decision aid Patients should already be screened
More informationAntithrombotic Therapy and Prevention of Thrombosis, 9 th Edition : ACCP Evidence-Based Clinical Practice Guidelines
Deep Venous Thrombosis and Pulmonary Thromboembolic Disease: Are we practicing evidence-based medicine? The 2012 ACCP Guidelines and Beyond (Buzz Lightyear) Jeffrey L. Garland, MD, FCCP Associate Chair
More informationCoagulation issues and bridging. Joost van Veen Consultant Haematologist - STHFT
Coagulation issues and bridging Joost van Veen Consultant Haematologist - STHFT new oral anticoagulants NOAC New oral anticoagulants NOAC Novel oral anticoagulants NOAC Non vitamin K oral anticoagulants
More informationA PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS
A PRACTICAL REVIEW OF THE NOVEL ORAL ANTICOAGULANTS BRIAN CRYDER, PHARMD BCACP LEARNING OBJECTIVES AS A RESULT OF THIS PRESENTATION, THE AUDIENCE WILL BE ABLE TO 1. DISCUSS THE KEY DIFFERENCES BETWEEN
More informationNWMIC Medicines FAQ. New oral anticoagulants (NOACs) and management of dental patients - Dabigatran, rivaroxaban and apixaban.
NWMIC Medicines FAQ New oral anticoagulants (NOACs) and management of dental patients - Date prepared: May 2013, updated November 2013 Summary In primary care; Consider liaising with the local hospital
More informationTime of Offset of Action The Trial
New Antithrombotic Agents DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant Amgen Tom DeLoughery, MD FACP FAWM Oregon Health and Sciences University What I am Talking About
More informationNew 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 informationMEDICAL 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 informationAdverse Drug Events (ADEs) Heparin and warfarin constitute 2 of the top 3 medications requiring
Improving Quality: Anticoagulation Therapy Mark Wurster, MD Founder and Chief Medical Officer Standing Stone, Inc. Scope of the Problem Adverse Drug Events (ADEs) Heparin and warfarin constitute 2 of the
More informationNEWER 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 informationHypercoagulability How to Expect the Unexpected. Beth Saft, DO VOMA Conference 2012
Hypercoagulability How to Expect the Unexpected Beth Saft, DO VOMA Conference 2012 Who is at Risk Most Common Hypercoagulability Objectives + When to Test What to do with the Test Results Who gets a DVT
More informationDISCLAIMER ARTHROPLASTY SOCIETY VTE INFORMATION
DISCLAIMER ARTHROPLASTY SOCIETY VTE INFORMATION Venous thromboembolism is the most common complication after total hip and total knee arthroplasty. In recent times members of the Australian Orthopaedic
More informationPRACTICE GUIDELINES FOR ANTICOAGULATION MANAGEMENT
PRACTICE GUIDELINES FOR ANTICOAGULATION MANAGEMENT 3 RD EDITION From the Division of Hematology and Pharmacy with contributions from the Division of Cardiology, the Thrombosis Research Group, Department
More information45 yo fall from ladder
DVT and PE Prophylaxis in Lower Extremity Trauma Daniel T. Altman, MD Associate Professor of Orthopaedic Surgery Drexel University College of Medicine Temple University School of Medicine Allegheny General
More informationThree new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
More informationThrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare
Thrombosis management: A time for change practical management with NOACs Dr Wala Elizabeth Medical Director, Bayer Healthcare Kenya Association of Physicians Conference 10 th May 2013 New anticoagulants:
More informationTSOAC 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 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 informationUse 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 informationMEDICAL 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 informationClinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to
Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals DRAFT FOR PUBLIC CONSULTATION 2009 Commonwealth
More information