Welcome to the New England QIN-QIO Medication Safety Webinar!
|
|
- Millicent Sutton
- 6 years ago
- Views:
Transcription
1 Welcome to the New England QIN-QIO Medication Safety Webinar! Thank you for joining. Our presentation will begin shortly. If you haven t already, please dial in to the audio line: Passcode: Slides may be downloaded at:
2 The New England Journey Enhancing Medication Safety Anticoagulation in the Ambulatory Setting Clinical Guidelines & Protocols May 9, :00pm 1:00pm This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO), the Medicare Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy CMSQINC
3 Speaker Disclosures Today s speakers have no relevant conflicts of interest to disclose In adherence to the regulation standards of the Connecticut Pharmacists Association, the Accreditation Council of Pharmacy Education, Northeast Multistate Division (NE-MSD) this notice confirms that the information contained in this presentation is free of commercial bias and the speakers have no related vested financial interest in any capacity, inclusion of shareholder, recipient of research grants, consulting or advisory committees. 3
4 Chat in Introduce yourself please type in your name, organization and state. 4
5 Learning Objectives Upon completion of this session, participants will be able to: Discuss the patient types most likely to benefit from using a direct acting oral anticoagulant over warfarin, Describe an appropriate monitoring strategy to prevent adverse drug events in patients receiving direct acting oral anticoagulants, and Explore treatment options and available agents to reverse the effects of direct acting oral anticoagulants. 5
6 Adverse Drug Event (ADE) Defined as injury resulting from medical intervention related to a drug 6
7 Adverse Drug Events Implications 1/3 of hospital adverse events 1 280,000 hospital admissions annually 1 One-quarter of all ADEs are preventable 3 The CDC estimates that $3.5 billion is spent on extra medical costs associated with ADEs every year Hospital admissions related to ADEs in adults > 65 years was 24.9% 2 1 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, D.C.: Koh, H. 2 Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiology and Drug Safety. September 2010;19(9): Neumiller J, Corbett C. Prevention of Medication Errors in the Older Adult Patient. Postgraduate Healthcare Education, LLC. Power- Pak C.E. Mylan Pharmaceuticals,
8 The National Action Plan for Adverse Drug Event (ADE) Prevention Department of Health & Human Services Identifies efforts to measure and prevent ADEs Patient Safety Prevention of ADE among three classes Diabetic agents Opioids Anticoagulants 8
9 Why Anticoagulants? 10% of inpatient ADEs due to anticoagulants 1 Warfarin caused 17% of ER visits in older adults 1 33% of ADE hospitalizations due to warfarin 1 1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, DC: Author.
10 Anticoagulants Prescribed for treatment/prevention of Atrial fibrillation (AFib) and venous thromboembolism (VTE) Warfarin is most commonly prescribed anticoagulant Direct oral anticoagulants (DOACs) Pradaxa (Dabigatran) Xarelto (Rivaroxaban) Eliquis (Apixaban) Savaysa (Edoxaban) 10
11 Anticoagulation in the Ambulatory Setting Clinical Guidelines & Protocols Michael L. Smith, Pharm.D., BCPS, CACP East Region Pharmacy Clinical Manager Hartford Healthcare
12 Anticoagulation Therapy Options Since 1954 warfarin was the only choice for oral anticoagulation therapy Dabigatran ushered in a new era & options Rivaroxaban Apixaban Edoxaban No requirement for consistent monitoring/dose adjustments
13 Are DOACs an option for this patient? Proven safe & effective as warfarin for... Nonvalvular Atrial fibrillation Treatment and prevention of DVT/PE Not proven for... Atrial fibrillation associated with valvular disease Prophylaxis of mechanical valves VTE treatment and prevention in patients with cancer, pregnancy, or antiphospholipid syndrome.
14 Recommended Monitoring Warfarin Adherence counseling Drug interactions Dietary interactions Adverse event monitoring Regular interaction with a healthcare professional DOACs
15 JUST SET IT AND FORGET IT
16 Direct Oral Anticoagulants Standard tenants of drug therapy still apply Why? How? What to look for? Poor Adherence = Poor Outcomes = ADE VA study determined 28% of patients are non-adherent to dabigatran 13% increase in all-cause mortality and stroke for each 10% decrease in adherence Shore S. Am Heart J 2014;167:810-17
17 Direct Oral Anticoagulants Can we improve DOAC outcomes with monitoring? VA study follow-up examined adherence rates across the system Improved adherence demonstrated with a pharmacist review of appropriate patient selection and pharmacist-led monitoring Adherence increased with longer duration of follow-up Shore S. JAMA 2015;313(14):
18 Direct Oral Anticoagulants DOACs, Yes they are complicated! Rivaroxaban Dosing and Administration Atrial fibrillation 20mg once daily with the evening meal for CrCl>50 ml/min 15mg once daily with the evening meal for CrCl ml/min Contraindicated in patients with CrCl<15 ml/min Treatment of DVT/PE 15mg twice daily with food for the first 21 days 20mg once daily with food for the remainder of the treatment Contraindicated in patients with CrCl<30 ml/min Prophylaxis of DVT following hip or knee replacement surgery Administer without regard to food Hip: 10mg once daily for 35 days Knee: 10mg once daily for 12 days Contraindicated in patients with CrCl<30 ml/min Xarelto package insert 18
19 Monitoring Plan At therapy initiation Confirm appropriateness of therapy Obtain baseline labs (CBC/LFTs/SCr) Calculate creatinine clearance (CrCl) using Cockcroft-Gault Conduct medication review to assess potential for drug interactions Review indication for therapy Provide education to patient, supplemented by written materials agement.pdf. Accessed 10/27/2015
20 Patient Monitoring Thrombosis Canada: Suggested follow up in weeks 1 + 3, months 3 and 6, then every 6 months. Adherence Assessment and Counseling Bleeding Risk Assessment Creatinine Clearance Drug Interaction Assessment and Counseling Examination Final Assessment and Follow-up Gladstone DJ, Geerts WH, Douketis J, Ivers N, Healey JS, Leblanc K. Ann Intern Med. 2015;163:
21 Management Plan Flow Chart agement.pdf. Accessed 10/27/2015
22 Anticoagulation Reversal Dabigatran associated bleeding Mild-moderate bleeding: supportive therapy only Severe-life threatening: Praxbind (Idarucizumab) 5gm IV Praxbind package insert 10/2015
23 Anticoagulation Reversal Idarucizumab Indication: Reversal of the anticoagulant effect of dabigatran for emergency surgery/urgent procedures or life threatening or uncontrolled bleeding A humanized monoclonal antibody fragment with a high affinity to dabigatran and neutralizes the effect of dabigatran Onset: 5 minutes Duration: 24 hrs, the complex is renally cleared; no change if patient has severe renal disease Praxbind package insert 10/2015
24 Anticoagulation Reversal Available as 2 X 2.5gm/50ml ready to administer vials Thromboembolic Risk: Reversing dabigatran therapy exposes patients to the thrombotic risk of their underlying disease. Resume anticoagulant therapy as soon as medically appropriate. In patients with elevated coagulation parameters and reappearance of clinically relevant bleeding or requiring a second emergency surgery/urgent procedure, an additional 5 g dose may be considered. Praxbind package insert 10/2015
25 Anticoagulation Reversal Warning: In patients with the condition of hereditary fructose intolerance who have received parenteral administration of sorbitol, serious adverse reactions, including fatal reactions, have been reported. Reactions have included hypoglycemia, hypophosphatemia, metabolic acidosis, increase in uric acid, acute liver failure with breakdown of excretory and synthetic function. Praxbind package insert 10/2015
26 Anticoagulation Reversal Rivaroxaban, Apixaban, Edoxaban associated bleeding Mild-moderate: Supportive therapy only Severe-life threatening: Tranexamic acid 1gm IV Consider off-label 4 factor PCC (Kcentra ) units/kg, max dose 5000 units. Consider off-label FEIBA units/kg Consider vitamin K for underlying deficiency Faraoni et al. Critical Care (2015) 19:203 Shamoun et al. BioMed Res Int (2015) 2015:424031
27 Anticoagulation Reversal 4 factor Prothrombin Complex Concentrate (PCC)- Kcentra Indicated for the urgent reversal of acquired coagulation factor deficiency induced by Vitamin K antagonist (VKA, e.g., warfarin) therapy in adult patients with: acute major bleeding or need for an urgent surgery/invasive procedure 25 X more concentrated than FFP Replaces coagulation factors II, VII, IX and X Also contains proteins C and S and *heparin* Onset: 5-10 mins; Duration: 12-24hrs Kcentra package insert 12/2013
28 Anticoagulation Reversal AndexXa (Andexanet alfa) A recombinant protein designed to reverse the activity of both direct and indirect Factor Xa inhibitors Developed as a universal reversal agent for patients anticoagulated with an oral or injectable Factor Xa inhibitor. Designated a Breakthrough Therapy by the U.S. Food and Drug Administration
29 Anticoagulation Reversal On August 17, 2016, the FDA released a Complete Response Letter which raised questions regarding manufacturing and clinical data. Currently being studied in ANNEXA-4, a Phase 3b/4 single-arm, open-label confirmatory study in patients receiving apixaban, rivaroxaban, edoxaban or enoxaparin who present with an acute major bleed.
30 Suggested Resources UW Medicine Anticoagulation Services Thrombosis Canada The Michigan Anticoagulation Quality Improvement Initiative 30
31 We Want to Hear from You We will open the phone lines so you can pose your questions and share own experiences 31
32 Key Takeaways Adverse Drug Events (ADEs), a leading cause of ED visits & hospitalizations, can be prevented Anticoagulants account for approximately 1/3 of the ED visits due to ADEs It s important to understand which anticoagulation therapy is best suited for your patient It s critical to implement a standard monitoring process for all patients on anticoagulation therapy There are known treatment options that can reverse the effects of direct acting oral anticoagulants 32
33 Maine Amanda Gagnon X 3108 Massachusetts Colleen Kordana ckordana@healthcentricadvisors.org X3202 Rhode Island Cynthia Stephanopoulos cstephanopoulos@healthcentricadvisors.org Contact Your Medication Safety State Lead Connecticut, New Hampshire & Vermont Margherita Giuliano, RPh, CAE mgiuliano@ctpharmacists.org Questions regarding CE status may be submitted to Justin Sacramone at jsacramone@healthcentricadvisors.org 5/9/
34 Upcoming Learning Events Medication Safety Lunch & Learn Series (12pm-1pm) July 7/11: Maintaining Glycemic Control 7/25: Tools and Tips to Enhance Safe Care Transitions for Type II Diabetics Learn more, view archived events or register for upcoming session on our event page
35 Connect with the New England QIN-QIO on Social Media! 35
Chapter 1 The Reversing Agents
Available Strategies to Reverse Anticoagulant Medications Michael L. Smith, Pharm. D., BCPS, CACP East Region Pharmacy Clinical Manager Hartford HealthCare Objectives: Describe the pharmacological agents
More informationUpdate on Oral Anticoagulants. Dr. Miten R. Patel Cancer Specialists of North Florida Cell
Update on Oral Anticoagulants Dr. Miten R. Patel Cancer Specialists of North Florida Cell 904-451-9820 Email miten.patel@csnf.us Overview Highlights of the 4 new approved oral anticoagulants Results from
More informationReversal Agents for Anticoagulants Understanding the Options. Katisha Vance, MD, FACP Alabama Oncology January 28, 2017
Reversal Agents for Anticoagulants Understanding the Options Katisha Vance, MD, FACP Alabama Oncology January 28, 2017 Objectives Appropriately recommend reversal agents for Vitamin K antagonists Appropriately
More informationThe INR: No Need Anymore? Daniel Blanchard, MD Professor of Medicine Director, Cardiology Fellowship Program UCSD Sulpizio Cardiovascular Center
The INR: No Need Anymore? Daniel Blanchard, MD Professor of Medicine Director, Cardiology Fellowship Program UCSD Sulpizio Cardiovascular Center What is the INR? Tissue Factor (Factor III) is added to
More informationWhat s new with DOACs? Defining place in therapy for edoxaban &
What s new with DOACs? Defining place in therapy for edoxaban & Use of DOACs in cardioversion Caitlin M. Gibson, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy University of North Texas
More informationAnticoagulation Task Force
Anticoagulation Task Force Newest Recommendations Donald Zabriskie, BPharm, MBA, RPh Pharmacy Patient Care Services Cleveland Clinic- Fairview Hospital THE DRUGS THE PERFECT ANTICOAGULANT Oral administration
More informationUpdates in Anticoagulation for Atrial Fibrillation and Venous Thromboembolism
Disclosures Updates in Anticoagulation for Atrial Fibrillation and Venous Thromboembolism No financial conflicts of interest Member of the ABIM Focused- Practice in Hospital Medicine Self Examination Process
More informationThe INR: No Need Anymore? Daniel Blanchard, MD Professor of Medicine Director, Cardiology Fellowship Program UCSD Sulpizio Cardiovascular Center
The INR: No Need Anymore? Daniel Blanchard, MD Professor of Medicine Director, Cardiology Fellowship Program UCSD Sulpizio Cardiovascular Center What is the INR? Tissue Factor (Factor III) is added to
More informationDirect Oral Anticoagulants An Update
Oct. 26, 2017 Direct Oral Anticoagulants An Update Kathleen Heintz, DO, FACC Assistant Professor of Medicine Cooper Heart Institute Direct Oral Anticoagulants: DISCLAIMERS No Conflicts of Interest So what
More informationOral Anticoagulants Update. Elizabeth Renner, PharmD, BCPS, BCACP, CACP Outpatient Cardiology and Anticoagulation
Oral Anticoagulants Update Elizabeth Renner, PharmD, BCPS, BCACP, CACP Outpatient Cardiology and Anticoagulation Objectives List the direct oral anticoagulant (DOAC) drugs currently available Describe
More informationGuideline for Treatment of Head Injury in the Anticoagulated Patient
Guideline for Treatment of Head Injury in the Anticoagulated Patient GUIDELINE: GUIDELINE FOR TREATMENT OF HEAD INJURY IN THE ANTICOAGULATED PATIENT BACKGROUND: Chronic anticoagulation therapy is used
More informationProfessional Practice Minutes December 7, 2016
Professional Practice Minutes December 7, 2016 **New Opportunity for Patient Education** We can now request the educational videos we want our patients to watch after our visit. Video topics include colon
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Oral Anticoagulants Page 1 of 7 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Oral Anticoagulant - Bevyxxa (betrixaban), Eliquis (apixaban), Pradaxa (dabigatran),
More informationEmergency Management of Patients on Direct Oral Anticoagulants (DOACs)
Emergency Management of Patients on Direct Oral Anticoagulants (DOACs) Dr Tina Biss Consultant Haematologist Newcastle upon Tyne Hospitals NHS Foundation Trust NE RTC Annual Education Symposium 11 th October
More informationOral Anticoagulation Drug Class Prior Authorization Protocol
Oral Anticoagulation Drug Class Prior Authorization Protocol Line of Business: Medicaid P & T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review
More informationReversal of direct oral anticoagulants in the patient with GI bleeding. Marc Carrier
Reversal of direct oral anticoagulants in the patient with GI bleeding Marc Carrier Disclosure Faculty: Dr. Marc Carrier Relationships with commercial interests: Grants/Research Support: Leo Pharma, Bristol
More informationDo s and Don t of DOACs DISCLOSURE
Do s and Don t of DOACs Tom DeLoughery, MD MACP FAWM Oregon Health and Sciences University DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant/Research none Content Expert: Elsevier
More informationThe DOACs. Update on Anticoagulation 10/20/2017. Dabigatran (Pradaxa ) Rivaroxaban (Xarelto ) Apixaban (Eliquis ) Edoxaban (Savaysa ) Objectives
Objectives Update on Anticoagulation JEFF REIST PHARMD, BCPS CLINICAL ASSOCIATE PROFESSOR UNIVERSITY OF IOWA COLLEGE OF PHARMACY At the conclusion of this program, the participant should be able to: List
More informationINR as a Biomarker: Anticoagulation in Atrial Fib, Heart Failure, and Cardiovascular Disease Daniel Blanchard, MD, FACC, FAHA
INR as a Biomarker: Anticoagulation in Atrial Fib, Heart Failure, and Cardiovascular Disease Daniel Blanchard, MD, FACC, FAHA Professor of Medicine Director, Cardiology Fellowship Program Sulpizio Cardiovascular
More informationReversal of Novel Oral Anticoagulants. Angelina The, MD March 22, 2016
Reversal of Novel Oral Anticoagulants Angelina The, MD March 22, 2016 Argatroban Bivalirudin Enoxaparin Lepirudin Heparin Dabigatran Apixaban 1939 1954 1998 2000 1999 2001 10/2010 7/2011 12/2012 1/2015
More information3/19/2012. What is the indication for anticoagulation? Has the patient previously been on warfarin? If so, what % of the time was the INR therapeutic?
Abigail E. Miller, PharmD, BCPS Clinical Specialist, Cardiology University of North Carolina Hospitals I have no personal financial relationships with the manufacturers of the products to disclose. Boehringer
More informationThe Direct Oral Anticoagulants: Practical Considerations. David Garcia, MD University of Washington Seattle Cancer Care Alliance September 2015
The Direct Oral Anticoagulants: Practical Considerations David Garcia, MD University of Washington Seattle Cancer Care Alliance September 2015 Disclosure Occasional consultant to : BMS, Pfizer, Daiichi
More informationA Cascade of Updates: Hot Topics in Anticoagulation
A Cascade of Updates: Hot Topics in Anticoagulation Heather A. Powell, PharmD, BCPS Assistant Professor of Clinical Sciences Roosevelt University College of Pharmacy Golden L. Peters, PharmD, BCPS Associate
More informationEverything Your Pharmacist Wished You Knew About Anticoagulant Reversal Darrel W. Hughes, Pharm.D., BCPS University Health System & UT Health Science
Everything Your Pharmacist Wished You Knew About Anticoagulant Reversal Darrel W. Hughes, Pharm.D., BCPS University Health System & UT Health Science Center at San Antonio Department of Pharmacotherapy
More informationDrug Class Monograph
Drug Class Monograph Class: Oral Anticoagulants Drug: Coumadin (warfarin), Eliquis (apixaban), Pradaxa (dabigatran), Savaysa (edoxaban), arelto (rivaroxaban) Formulary Medications: Eliquis (apixaban),
More informationDisclosure and Conflict of Interest
A Cascade of Updates: Hot Topics in Anticoagulation Heather A. Powell, PharmD, BCPS Assistant Professor of Clinical Sciences Roosevelt University College of Pharmacy Golden L. Peters, PharmD, BCPS Associate
More informationClinical issues which drug for which patient
Anticoagulants - a matter of heart! Towards a bright future? Clinical issues which drug for which patient Sabine Eichinger Dept. of Medicine I Medical University of Vienna/Austria Conflicts of interest
More informationNew Age Anticoagulants: Bleeding Considerations
Ontario Regional Blood Coordinating Network March 23, 2012 New Age Anticoagulants: Bleeding Considerations Bill Geerts, MD, FRCPC Thromboembolism Specialist, Sunnybrook HSC Professor of Medicine, University
More information10 Key Things the Vascular Community Should Know about the DOACs Heather Gornik, MD, RVT, RPVI
10 Key Things the Vascular Community Should Know about the DOACs Heather Gornik, MD, RVT, RPVI Cleveland Clinic Heart and Vascular Institute Heather L. Gornik, MD has the following relationships to disclose:
More informationNOACS/DOACS*: COMPARISON AND FREQUENTLY-ASKED QUESTIONS
NOACS/DOACS*: COMPARISON AND FREQUENTLY-ASKED QUESTIONS OBJECTIVES: To provide a comparison of the newer direct oral anticoagulants (DOACs) currently available in Canada. To address frequently-asked questions
More informationLeading the Charge in Anticoagulation Reversal: Benefits, Risks, and Key Factors in Application to the Traumatically Injured Patient
Leading the Charge in Anticoagulation Reversal: Benefits, Risks, and Key Factors in Application to the Traumatically Injured Patient Emily Hutchison, PharmD BCPS Clinical Pharmacy Specialist, Trauma/Adult
More informationNew Anticoagulants Therapies
New Anticoagulants Therapies Rachel P. Rosovsky, MD, MPH October 22, 2015 Conflicts of Interest No disclosures 2 Agenda 3 Historical perspective Novel oral anticoagulants Stats Trials Approval Concerns/Limitations
More informationNew and old anticoagulants. Anticoagulation Focus on Direct Oral Anticoagulants
Anticoagulation Focus on Direct Oral Anticoagulants Tzu-Fei Wang, MD Assistant Professor Department of Internal Medicine Division of Hematology The Ohio State University Wexner Medical Center Objectives
More informationSAVAYSA (edoxaban tosylate) oral tablet
SAVAYSA (edoxaban tosylate) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
More informationChallenging Anticoagulation Case Studies. Earl J. Hope, M.D. Tower Health Cardiology
Challenging Anticoagulation Case Studies Earl J. Hope, M.D. Tower Health Cardiology Financial Disclosures Nothing to disclose Objectives: 1. Understand indications for heparin bridging. 2. Recognize the
More informationNEWSLETTER DUE CARE PROGRAM. WINTER 2014 Summer 2015 COMMONLY ASKED QUESTION:
DUE CARE PROGRAM NEWSLETTER WINTER 2014 Summer 2015 Lisa Sather, RPh DUR Coordinator Mountain-Pacific Quality Health 3404 Cooney Drive Helena, MT 59602 406-457-5818 The DUE CARE PROGRAM, administered by
More informationDrug Use Criteria: Direct Oral Anticoagulants
Texas Vendor Drug Program Drug Use Criteria: Oral Anticoagulants Publication History 1. Developed March 2017. 2. Revised February 2018. Notes: Information on indications for use or diagnosis is assumed
More informationComparison of novel oral anticoagulants (NOACs)
Comparison of novel oral anticoagulants (NOACs) For guidance for full information refer to individual SPCs available at www.medicines.org.uk Licensed indications for NOACs Prevention of stroke and systemic
More informationCanadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC
Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC DEBATE: DOAC vs Good Old Warfarin André Roussin MD, FRCP, CSPQ CHUM and ICM/MHI Associate professor University of Montreal A. Roussin
More informationManaging Bleeding in the Patient on DOACs
Managing Bleeding in the Patient on DOACs Spring 2016 Jean M. Connors, MD Anticoagulation Management Services BWH/DFCI Hemostatic Antithrombotic Stewardship BWH Assistant Professor of Medicine, HMS Conflicts
More informationAnticoagulation with Direct oral anticoagulants (DOACs) and advances in peri-procedural interruption of anticoagulation-- Bridging
Anticoagulation with Direct oral anticoagulants (DOACs) and advances in peri-procedural interruption of anticoagulation-- Bridging Scott C. Woller, MD Co-Director, Thrombosis Program Intermountain Medical
More informationWarfarin for Long-Term Anticoagulation. Disadvantages of Warfarin. Narrow Therapeutic Window. Warfarin vs. NOACs. Challenges Monitoring Warfarin
1 2:15 pm The Era of : Selecting the Best Approach to Treatment SPEAKER Gregory Piazza, MD, MS Presenter Disclosure Information The following relationships exist related to this presentation: Gregory Piazza,
More information3/25/2016. Objectives for Pharmacists. Stop the Bleeding! New Reversal Agents. Objectives for Pharmacy Technicians. Assessment Pre-test
Objectives for Pharmacists Stop the Bleeding! New Reversal Agents Gary D Peksa, Pharm.D., BCPS Clinical Pharmacy Specialist, Emergency Medicine Rush University Medical Center Review current strategies
More informationto a DOAC anticoagulants (DOACs) dosing of DOACs for various indications switching from a DOAC and switching
Linda Kelly, PharmD, PhC, CACP Presbyterian Healthcare Services } Identify the FDA approved direct oral anticoagulants (DOACs) } Distinguish the differences in the dosing of DOACs for various indications
More informationDirect Oral Anticoagulant Reversal
08 June 2018 No. 08 Direct Oral Anticoagulant Reversal M Khattab Moderator: E Hodgson School of Clinical Medicine Discipline of Anaesthesiology and Critical Care CONTENTS INTRODUCTION... 3 Pharmacokinetics
More informationIndividualizing VTE Treatment and Prevention of Recurrence: The Place for Direct Oral Anticoagulants in VTE
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationIntroduction. Blood Pressure
Introduction Spontaneous intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality worldwide [1]. Of a number of factors that have been linked to ICH (e.g., higher rates in Asians and
More informationEdoxaban. Direct Xa inhibitor Direct thrombin inhibitor Direct Xa inhibitor Direct Xa inhibitor
This table provides a summary of the pharmacotherapeutic properties, side effects, drug interactions and other important information on the four anticoagulant medications currently in use or under review
More informationUpdate on the NOAC s: 2018 Daniel Blanchard, MD, FACC, FAHA
Update on the NOAC s: 2018 Daniel Blanchard, MD, FACC, FAHA Professor of Medicine Director, Cardiology Fellowship Program Sulpizio Cardiovascular Center UC San Diego The NOACS, chronologically Dabigatran:
More informationNibal R. Chamoun, Pharm.D., BCPS Clinical Assistant Professor of Pharmacy Practice at the Lebanese American University Clinical Pharmacy Coordinator
Nibal R. Chamoun, Pharm.D., BCPS Clinical Assistant Professor of Pharmacy Practice at the Lebanese American University Clinical Pharmacy Coordinator at LAUMCRH Review the mechanism of action, indications
More informationChallenges in Coagulation
Challenges in Coagulation Michael H. Rosove, MD Clinical Professor of Medicine UCLA Division of Hematology-Oncology April 30, 2016 Vitamin K Deficiency Vitamin K1 source from diet Vitamin K2 source from
More informationNEW/NOVEL ORAL ANTICOAGULANTS (NOACS): COMPARISON AND FREQUENTLY ASKED QUESTIONS
NEW/NOVEL ORAL ANTICOAGULANTS (NOACS): COMPARISON AND FREQUENTLY ASKED QUESTIONS OBJECTIVES: To provide a comparison of the new/novel oral anticoagulants (NOACs) currently available in Canada. To address
More informationDirect Oral Anticoagulants
Direct Oral Anticoagulants Holly Jahn, PharmD, CACP Objectives Identify the FDA approved indications for use, appropriate dosing, and monitoring parameters for each direct oral anticoagulant. Distinguish
More informationManagement of Novel Oral Anticoagulants (NOACs) with the DAWN AC modules
Management of Novel Oral Anticoagulants (NOACs) with the DAWN AC modules Jane Vo, Pharm D. Anticoagulation Services Scripps Clinic and Scripps Green Hospital La Jolla, California Pharmacist Management
More informationAdvances in Anticoagulation
May 18, 2017 Advances in Anticoagulation Wei Ling Lau, MD Assistant Professor, Nephrology University of California, Irvine Talk Outline High stroke risk in CKD population Warfarin off-target effects on
More informationQUEST FOR THE IDEAL ANTICOAGULANT: A PATIENT-CENTERED APPROACH TO TREATMENT
QUEST FOR THE IDEAL ANTICOAGULANT: A PATIENT-CENTERED APPROACH TO TREATMENT SATURDAY/11:30AM-12:30PM ACPE UAN: 0107-9999-17-237-L01-T 0.1 CEU/1.0 hr Activity Type: Knowledge-Based Learning Objectives for
More informationAfib, Stroke, and DOAC. Albert Luo, MD. Cardiology Lindsey Frischmann, DO. Neurology Xiao Cai, MD. HBS
Afib, Stroke, and DOAC Albert Luo, MD. Cardiology Lindsey Frischmann, DO. Neurology Xiao Cai, MD. HBS Disclosure of Relevant Financial Relationships I have no relevant financial relationships with commercial
More informationPractical Considerations for Using Oral Anticoagulants in Patients with Chronic Kidney Disease
Practical Considerations for Using Oral Anticoagulants in Patients with Chronic Kidney Disease Cyrille K. Cornelio, Pharm.D. PGY2 Cardiology Pharmacy Resident The University of Oklahoma College of Pharmacy
More informationReversal Agents for NOACs (Novel Oral Anticoagulants)
Reversal Agents for NOACs (Novel Oral Anticoagulants) Current status and future challenges Paul A Reilly, PhD Clinical Research, Boehringer Ingelheim, Inc CSRC Symposium Washington DC Oct 18, 2016 Atrial
More informationManaging Perioperative Anticoagulation. Edie Shen MD
Managing Perioperative Anticoagulation Edie Shen MD Anticoagulation VKA Warfarin (Coumadin) DOACs Direct Thrombin Inhibitor Dabigatran (Pradaxa) Factor Xa Inhibitor Rivaroxaban(Xarelto) Apixaban(Eliquis)
More informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE July 5, 2016 SUBJECT EFFECTIVE DATE July 11, 2016 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Anticoagulants - Pharmacy Services Leesa M. Allen, Deputy Secretary
More informationREVERSAL STRATEGIES FOR ORAL ANTICOAGULATION
REVERSAL STRATEGIES FOR ORAL ANTICOAGULATION Wesley R. Zemrak, Pharm.D., BCPS Clinical Pharmacy Specialist, Anticoagulation Maine Medical Center, Portland, ME zemraw@mmc.org 1 OBJECTIVES 1. Discuss the
More informationEmergent Anticoagulation Reversal
U N C M E D I C A L C E N T E R G U I D E L I N E Emergent Anticoagulation Reversal I. PURPOSE: The purpose of these instructions is to provide guidelines for the reversal of or management of bleeding
More information6 th ACC-SHA Joint Meeting Jeddah, Saudi Arabia
6 th ACC-SHA Joint Meeting Jeddah, Saudi Arabia October 31 st - November 1 st, 2015 NOACS vs. Coumadin in Atrial Fibrillation: Is It Worth to Switch? Raed Sweidan, MD, FACC Consultant and Head of Cardiac
More informationUpdate on the Management of Cancer Associated VTE
Update on the Management of Cancer Associated VTE Jean M. Connors, MD 2018 Master Class Course Anticoagulation Management Services BWH/DFCI Hemostatic Antithrombotic Stewardship BWH Associate Professor
More informationNew Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY
New Oral Anticoagulants in treatment of VTE, PE DR.AMR HANAFY (LECTURER OF CARDIOLOGY ) ASWAN UNIVERSITY Fact VTE is deadly! It nibbles after it bites! The 30-day mortality rates for first-time DVT or
More informationA Brief History of the World of Anticoagulation
A Brief History of the World of Anticoagulation Allison Burnett, PharmD, CACP, PhC Clinical Assistant Professor- UNM College of Rx Antithrombosis Stewardship Pharmacist University of New Mexico Hospital
More informationNew Antithrombotic Agents DISCLOSURE
New Antithrombotic Agents DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau None Research Alexion (PNH) delought@ohsu.edu Tom DeLoughery, MD FACP FAWM Oregon Health and Sciences University What
More informationReversal of DOACs Breakthroughs and Their Aftermath
Reversal of DOACs Breakthroughs and Their Aftermath Geno J Merli, MD, MACP, FSVM, FHM Professor Medicine & Surgery Co-Director Jefferson Vascular Center Sidney Kimmel Medical College Thomas Jefferson University
More informationClinical Policy: Dabigatran (Pradaxa) Reference Number: CP.PMN.49 Effective Date: Last Review Date: 05.18
Clinical Policy: (Pradaxa) Reference Number: CP.PMN.49 Effective Date: 05.01.12 Last Review Date: 05.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationUpdates in Coagulation Thrombophilia testing and direct oral anticoagulants. Kevin Y. Chen, MD Hematology and Medical Oncology October 13, 2017
Updates in Coagulation Thrombophilia testing and direct oral anticoagulants Kevin Y. Chen, MD Hematology and Medical Oncology October 13, 2017 No conflicts of interest Introduction to thrombosis Hemostasis
More informationSee 17 for PATIENT COUNSELING INFORMATION.
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use PRAXBIND safely and effectively. See full prescribing information for PRAXBIND. PRAXBIND (idarucizumab)
More informationUPDATE OF NEUROCRITICAL CARE PHARMACOTHERAPY. Vera Wilson, PharmD, BCPS Emergency Services Clinical Pharmacy Specialist Johnson City Medical Center
UPDATE OF NEUROCRITICAL CARE PHARMACOTHERAPY Vera Wilson, PharmD, BCPS Emergency Services Clinical Pharmacy Specialist Johnson City Medical Center DISCLOSURE STATEMENT OF FINANCIAL INTEREST I, Vera Wilson,
More informationReversal of Anticoagulants at UCDMC
Reversal of Anticoagulants at UCDMC Introduction: Bleeding complications are a common concern with the use of anticoagulant agents. In selected situations, reversing or neutralizing the effects of an anticoagulant
More informationNewer Oral Anticoagulants and Available Reversal Agents. Cara L. Leos, Pharm D, BCPS AQ Cardiology Baptist Medical Center South Montgomery, AL
Newer Oral Anticoagulants and Available Reversal Agents Cara L. Leos, Pharm D, BCPS AQ Cardiology Baptist Medical Center South Montgomery, AL Disclosure Speakers bureau Boehringer Ingelheim As each of
More informationA Review of Direct-Acting Oral Anticoagulants (DOACs) and Their Use in Special Populations
A Review of Direct-Acting Oral Anticoagulants (DOACs) and Their Use in Special Populations Allison Bernard, PharmD PGY2 Ambulatory Care Resident University of Iowa Hospitals and Clinics October 25 th,
More informationSouthern Trust Anticoagulant Team
CLINICAL GUIDELINES ID TAG Title: Author: Speciality / Division: Directorate: Anticoagulation- Primary Care Guidance for reviewing patients on DOACs Southern Trust Anticoagulant Team Haematology Acute
More informationDrug Class Review Newer Oral Anticoagulant Drugs
Drug Class Review Newer Oral Anticoagulant Drugs Final Original Report May 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness and harms of different
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 informationIdarucizumab for Dabigatran Reversal Pollack CV, Reilly PA, Eikelboom J, et al. N Engl J Med 2015; 373(6):
Idarucizumab for Dabigatran Reversal Pollack CV, Reilly PA, Eikelboom J, et al. N Engl J Med 2015; 373(6):511-520. Objective: To measure the safety of idarucizumab to reverse dabigatran anticoagulant effects
More informationDOAC and NOAC are terms for a novel class of directly acting oral anticoagulant drugs including Rivaroxaban, Apixaban, Edoxaban, and Dabigatran.
Guideline for Patients on Direct Oral Anticoagulant Therapy Requiring Urgent Surgery for Hip Fracture Trust Ref:C10/2017 1. Introduction This guideline is for the clinical management of patients on direct
More informationThey re Not So New Anymore Update on NOAC s (Novel Oral Anticoagulants)
They re Not So New Anymore Update on NOAC s (Novel Oral Anticoagulants) Daniel B. DiCola, MD Paul W. Ament, PharmD Daniel DiCola, MD ddicola@excelahealth.org Faculty: Latrobe Area Hospital, Excela Health
More informationIntrinsic + Common = aptt. Extrinsic + Common = PT. Common Pathway
Anticoagulant Cases 12 11 Intrinsic + Common = aptt 9 8 10 7 4 Extrinsic + Common = PT 5 2 Common Pathway 1 Xa Inhibitors rivaroxaban (Xarelto) apixaban (Eliquis) edoxaban (Savaysa) What is true regarding
More informationAnticoagulation: Novel Agents
Anticoagulation: Novel Agents Scott C. Woller, MD Medical Director, Anticoagulation Management, Intermountain Healthcare Central Region, co-director Venous Thromboembolism Program, Intermountain Medical
More informationCopyright 2017 Wolters Kluwer Health, Inc. All rights reserved.
Paras Soni / 123RF RSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL VERSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL AGENTS REVERSAL
More informationEvent Name: Anticoagulation in the Ambulatory Setting Clinical Guidelines and Protocols Event Date: May 9, 2017 Event Time: 12:00pm 1:00pm EST
Event Name: Anticoagulation in the Ambulatory Setting Clinical Guidelines and Protocols Event Date: May 9, 2017 Event Time: 12:00pm 1:00pm EST Please stand by for real-time captions. Good afternoon everyone
More informationNOACS/DOACS*: COAGULATION TESTS
NOACS/DOACS*: COAGULATION TESTS OBJECTIVES: To describe the effect of the newer direct oral anticoagulants (DOACs) on laboratory coagulation tests which are widely available: prothrombin time (PT), international
More informationNanik Hatsakorzian Pharm.D/MPH
Pharm.D/MPH 2014 1 Therapeutics FDA indication & Dosing Clinical Pearls Anticoagulants Heparin Antiphospholipid antibody syndrome Cerebral thromboembolism Prosthetic heart valve Acute coronary syndrome
More informationDisclosures. Overview. Have you ever. The Perioperative Management of Anticoagulants. No financial conflicts of interest to disclose
Disclosures No financial conflicts of interest to disclose The Perioperative Management of Anticoagulants Margaret C. Fang, MD, MPH Associate Professor of Medicine UCSF Division of Hospital Medicine Medical
More informationPreparing for new Joint Commission EPs effective July 1: Best Practices in Anticoagulant Therapy Webinar
Preparing for new Joint Commission EPs effective July 1: Best Practices in Anticoagulant Therapy Webinar 9-10 am (PT) 10-11 am (MT) 11 am-12 pm (CT) 12-1 pm (ET) April 2, 2019 Preparing for new Joint Commission
More informationUse of Anticoagulant Reversal Agents
Use of Anticoagulant Reversal Agents Lori Shutter, MD shutterla@upmc.edu Vice Chair of Education Director, Neurocritical Care Program Professor, Critical Care Medicine, Neurology & Neurosurgery University
More informationADVOCATE HEALTHCARE GUIDELINE FOR ANTITHROMBOTIC REVERSAL
Minimal clinical evidence exists to support the efficacy of nonspecific procoagulant therapies that promote thrombin formation and antifibrinolytics in the setting of antithrombotic-related bleeding. Hemostatic
More informationManagement of haemorrhage in patients taking DOACs/ NOACs (direct/ novel oral anticoagulants) Guideline. Contents
Management of haemorrhage in patients taking DOACs/ NOACs (direct/ novel oral anticoagulants) Guideline Classification: Clinical Guideline Lead Author: Dr Rowena Thomas-Dewing, Consultant Haematologist
More informationSupplementary Online Content
Supplementary Online Content Caldeira D, Canastro M, Barra M, et al. Risk of substantial intraocular bleeding with novel oral anticoagulants: systematic review and meta-analysis. JAMA Ophthalmol. Published
More informationTrue/False: Idarucizumab can be utilized for the management of bleeding associated with dabigatran.
Discuss the role of idarucizumab for the management of bleeding associated with dabigatran Understand dosing, preparation and administration of idarucizumab I have no financial interest/arrangement or
More informationDOAC for VTE. Direct Oral Anticoagulants Clint Shedd DNP, FNP-BC Emory University
DOAC for VTE Direct Oral Anticoagulants Clint Shedd DNP, FNP-BC Emory University No disclosures Direct Oral Anticoagulants Understand VTE and the ACCP s position on it List the DOACs available in the US
More informationContent 1. Relevance 2. Principles 3. Manangement
Intracranial haemorrhage and anticoagulation Department of Neurology,, Germany Department of Neurology, Heidelberg University Hospital, Germany Department of Clinical Medicine Copenhagen University, Denmark
More informationNew Antithrombotic Agents
New Antithrombotic Agents Tom DeLoughery, MD FACP FAWM Oregon Health and Sciences University DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau None What I am Talking About 1. New Antithrombotic
More informationXarelto (rivaroxaban)
Xarelto (rivaroxaban) Policy Number: 5.01.575 Last Review: 7/2018 Origination: 6/2014 Next Review: 7/2019 LoB: ACA Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for Xarelto
More information