NeuroPI Case Study: Anticoagulant Therapy
|
|
- Lee Parker
- 6 years ago
- Views:
Transcription
1 Case: An 82-year-old man presents to the hospital following a transient episode of left visual field changes. His symptoms lasted 20 minutes and resolved spontaneously. He has a normal neurological examination in the emergency department and is admitted to the hospital for a TIA work-up. His past medical history is significant for hypertension. His current medications include daily aspirin and an antihypertensive medication, of which he can t recall the name. On the first night of hospitalization, the telemetry monitor detects that his heart rhythm converted to atrial fibrillation. He is started on a beta-blocker for rate control. His primary care doctor asks for your opinion on anticoagulation for secondary stroke prevention. You calculate his CHADS2 Score to be 4 and estimate his annual risk of stroke to be at least 8.5%. You recommend starting an anticoagulant now, either Heparin bridging to Coumadin or one of the newer anticoagulants that become therapeutic rapidly. Rationale: Atrial fibrillation affects over 2 million people in the United States and causes approximately 70,000 annual strokes. 1, 2 Paroxysmal, persistent, and permanent atrial fibrillation all are associated with an equally increased risk of stroke. Those patients with prior stroke or TIA are at particularly elevated risk and have a 2.5-fold increased risk of stroke over other patients with atrial fibrillation. 1 On average, stroke patients with atrial fibrillation have an estimated 12% per year rate of recurrent stroke. 3 However, this rate is affected by other vascular risk factors, such as coexisting hypertension, congestive heart failure, and diabetes. 4 The CHADS2 score (Figure) is a validated stratification scheme that assigns risk of stroke based on these additional risk factors in patients with atrial fibrillation. 4 Risk Factor CHADS2 Score Annual Stroke Rate without Antithrombotic Therapy Congestive Heart Failure = % Hypertension = % Age > 75 years = % Diabetes = % Prior Stroke/TIA = % % % Figure. CHAD2 Score 2012 American Academy of Neurology Page 1
2 While antiplatelet agents have a modest effect on stroke risk reduction, oral anticoagulation is clearly superior at preventing recurrent events. A 2008 Cochrane Review of trials comparing dose adjusted warfarin to antiplatelet therapy reported reductions in both total vascular events (OR = 0.67; 95% CI = 0.50 to 0.91) and recurrent stroke (OR = 0.49; 95% CI = 0.33 to 0.72) in patients with prior stroke/tia treated with anticoagulation. 5 Dual antiplatelet therapy is also inferior to systemic anticoagulation for secondary stroke prevention in patients with atrial fibrillation. The ACTIVE-W trial reported recurrent stroke rates of 5.6% for subjects treated with aspirin plus clopidogrel compared to 3.9% per year for those on warfarin. 6 Major bleeding complications were similar in both groups and occurred in approximately 2% of patients. 6 Elderly patients with atrial fibrillation are often excluded from anticoagulant therapy because of perceived risk of increased complications. The BAFTA trial evaluated older patients with atrial fibrillation (age > 75 years) and revealed a 50% relative risk reduction in all strokes among those treated with warfarin (goal INR 2.0 to 3.0) compared to daily aspirin. 7 Importantly, there was no difference in major hemorrhagic complications between groups. Newer oral anticoagulant medications such as dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, factor Xa inhibitors, are potentially preferable alternatives to dose adjusted warfarin. The RE-LY study evaluated the efficacy of two doses of dabigatran (110 mg or 150 mg twice daily) compared to warfarin (goal INR 2.0 to 3.0) in 18,113 patients with atrial fibrillation, plus an additional risk factor for embolic event. 8 Dabigatran 150 mg twice daily was superior to warfarin in prevention of stroke or systemic embolism [Relative Risk (RR) = 0.66; 95% CI = 0.53 to 0.82] with similar safety profiles. 8 The ROCKET-AF study compared rivaroxaban (20 mg daily) to dose adjusted warfarin (goal INR 2.0 to 3.0) in 14,264 moderate-tohigh risk atrial fibrillation patients. 9 Rivaroxaban was found to be non-inferior to warfarin for prevention of all stroke and systemic embolization [Hazard Ratio (HR) = 0.79; 95% CI = 0.66 to 0.96]. 9 The effects of apixaban in patients with atrial fibrillation has been studied in two clinical trials, ARISTOTLE and AVERROES. 10, 11 The ARISTOTLE trial reported that apixaban was superior to warfarin (HR = 0.79; 95% CI = 0.66 to 0.95) with lower rates of major bleeding. 10 The AVERROES study, which compared apixaban to aspirin in patients with atrial fibrillation deemed poor candidates for anticoagulation, reported significantly lower embolic events (HR = 0.45; 95% CI = 0.32 to 0.62) with equivalent safety. 11 Both dabigatran and rivaroxaban have been approved by the U.S. Food and Drug Administration for prevention or stroke in patients with non-valvular atrial fibrillation. At the time of the writing of this module, apixaban had not yet been FDA approved. Anticoagulation is recommended by the American Heart Association/American Stroke Association and endorsed by the American Academy of Neurology for patients with a CHADS2 Score of 2 or above. 12, 13 Patients with atrial fibrillation should be prescribed an anticoagulant medication at discharge or have a medical reason for not prescribing documented in the medical record American Academy of Neurology Page 2
3 Evidence Base: NeuroPI Case Study: Anticoagulant Therapy The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: Administer antithrombotic therapy (oral anticoagulation or aspirin) to all patients with AF, except those with lone AF, to prevent thromboembolism. (ACC/AHA/ESC 1 )(Class I, Level of Evidence: A) It is recommended that clinicians use long-term oral anticoagulation (target INR of 2.5; range, 2.0 to 3.0) for prevention of stroke in atrial fibrillation patients who have suffered a recent stroke or TIA. Oral anticoagulation is also beneficial for prevention of recurrent stroke in patients with several other high-risk cardiac sources. (ACCP 2 ) (Grade 1A) For patients with ischemic stroke or TIA with persistent or paroxysmal AF, anticoagulation with adjusted-dose warfarin (target INR, 2.5; range 2.0 to 3.0) is recommended. (ASA 3 ) (Class I, Level of Evidence: A) Warfarin (Class I; Level of Evidence A), dabigatran (Class I; Level of Evidence B), apixaban (Class I; Level of Evidence B), and rivaroxaban (Class IIa; Level of Evidence B) are all indicated for the prevention of first and recurrent stroke in patients with nonvalvular AF. The selection of an antithrombotic agent should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in INR therapeutic range if the patient has been taking warfarin. 4 Dabigatran 150 mg twice daily is an efficacious alternative to warfarin for the prevention of first and recurrent stroke in patients with nonvalvular AF and at least 1 additional risk factor who have CrCl >30 ml/min (Class I; Level of Evidence B). (Furie, 2012) On the basis of pharmacokinetic data, the use of dabigatran 75 mg twice daily in patients with AFand at least 1 additional risk factor who have a low CrCl (15 30 ml/min) may be considered, but its safety and efficacy have not been established (Class IIb; Level of Evidence C). (Furie, 2012) Apixaban 5 mg twice daily is an efficacious alternative to aspirin in patients with nonvalvular AF deemed unsuitable for vitamin K antagonist therapy who have at least 1 additional risk factor and no more than 1 of the following characteristics: Age >80 years, weight <60 kg, or serum creatinine >1.5 mg/dl (Class I; Level of Evidence B). (Furie, 2012) Apixaban 5 mg twice daily is a relatively safe and efficacious alternative to warfarin in patients with nonvalvular AF deemed appropriate for vitamin K antagonist therapy who have at least 1 additional risk factor and no more than 1 of the following characteristics: Age >80 years, weight 2012 American Academy of Neurology Page 3
4 <60 kg, or serum creatinine >1.5 mg/dl, (Class I; Level of Evidence B). (Furie, 2012) In patients with nonvalvular AF who are at moderate to high risk of stroke (prior history of TIA, stroke, or systemic embolization or >2 additional risk factors), rivaroxaban 20 mg/d is reasonable as an alternative to warfarin (Class IIa; Level of Evidence B). (Furie, 2012) 1. American College of Cardiology, American Heart Association, European Society of Cardiology. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. J Am Coll Cardiol 2001; 38; 1266i-lxx. 2. Albers GW, Amarenco P, Easton JD, Sacco RL, and Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 2001;119; Sacco RL, Adams R, Albers G, Alberts MJ, et al. Guidelines for Preventions of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006;37: Furie KL, Goldstein LB, Albers GW, et al. Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2012;43: References: 1. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2011;42: Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology 2007;69: Hart RG, Sherman DG, Easton JD, Cairns JA. Prevention of stroke in patients with nonvalvular atrial fibrillation. Neurology 1998;51: Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285: Saxena R, Koudstaal P. Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack American Academy of Neurology Page 4
5 Cochrane Database Syst Rev 2004:CD Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006;367: Mant J, Hobbs FD, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007;370: Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361: Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365: Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365: Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011;364: Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42: Furie KL, Goldstein LB, Albers GW, et al. Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2012;43: American Academy of Neurology Page 5
Oral 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 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 informationMODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC
MODULE 1: Stroke Prevention in Atrial Fibrillation Benjamin Bell, MD, FRCPC Specialty: General Internal Medicine Lecturer, Department of Medicine University of Toronto Staff Physician, General Internal
More informationDraft Agreed by Cardiovascular Working Party 25 Jan Adoption by CHMP for release for consultation 17 Feb 2011
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 London, 25 January 2011 EMA/CHMP/68875/2011 Committee for Medicinal Products for Human Use (CHMP) Concept paper on the need for a guideline on clinical investigation
More informationUC SF. Division of General Internal Medicine UNIVERSITY OF CALIFORNIA SAN FRANCISCO, DIVISION OF HOSPITAL MEDICINE
Updates in the Management of Atrial Fibrillation Margaret C. Fang, MD, MPH Associate Professor of Medicine UCSF Division of Hospital Medicine Medical Director, Anticoagulation Clinic UC SF Division of
More informationAnti-thromboticthrombotic drugs
Atrial Fibrillation 2011: Anticoagulation strategies and clinical outcomes Panos E. Vardas President Elect of the ESC, Prof. of Cardiology, University Hospital of Crete Clinical outcomes affected by AF
More informationNUOVI ANTICOAGULANTI NELL ANZIANO: indicazioni e controindicazioni. Mario Cavazza Medicina d Urgenza Pronto Soccorso AOU di Bologna
NUOVI ANTICOAGULANTI NELL ANZIANO: indicazioni e controindicazioni Mario Cavazza Medicina d Urgenza Pronto Soccorso AOU di Bologna Two major concerns Atrial Fibrillation: Epidemiology The No. 1 preventable
More informationDo Not Cite. Draft for Work Group Review.
Defect Free Acute Inpatient Ischemic Stroke Measure Bundle Measure Description Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke OR transient ischemic attack who were admitted
More informationShow Me the Outcomes!
Show Me the Outcomes! Real-World Safety Data on Oral Anticoagulants in Nonvalvular Atrial Fibrillation Gabby Anderson, PharmD PGY1 Pharmacy Resident anderson.gabrielle@mayo.edu Pharmacy Grand Rounds October
More informationNew options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital Disclosures: Honoraria, research support, and consulting f Sanofi, Boehringer-Ingleheim, Portola, BMS, Bayer,
More informationPros and Cons of Individual Agents Based on Large Trial Results: RELY, ROCKET, ARISTOTLE, AVERROES
Pros and Cons of Individual Agents Based on Large Trial Results: RELY, ROCKET, ARISTOTLE, AVERROES Ralph L. Sacco, MS MD FAAN FAHA Olemberg Family Chair in Neurological Disorders Miller Professor of Neurology,
More informationESC Congress 2012, Munich
ESC Congress 2012, Munich Anticoagulation in Atrial Fibrillation 2012: Which Anticoagulant for Which Patient? Stefan H. Hohnloser J.W. Goethe University Frankfurt am Main S.H.H. has served as a consultant,
More informationIndications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute
Indications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute Disclosures Research Support/P.I. Employee Leo Pharma
More informationAntithrombotics in Stroke management
Antithrombotics in Stroke management Faculty: Robert Beveridge Relationships with commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: Astra Zeneca, Bayer, Boerhinger Ingelheim,
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 informationADC Slides for Presentation 02/10/2017
ADC 2017 Slides for Presentation ANTI THROMBOTIC THERAPY FOR NON VALVULAR ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: CURRENT VIEWS Martin A. Alpert, MD Brent M. Parker Professor of Medicine
More informationDiscuss the role of idarucizumab 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 informationApixaban for stroke prevention in atrial fibrillation. August 2010
Apixaban for stroke prevention in atrial fibrillation August 2010 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to
More informationStepheny Sumrall, FNP, AGACNP Cardiovascular Clinic of Hattiesburg
Novel Oral Anticoagulants Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for the Treatment of Atrial Fibrillation and Prevention of Stroke Stepheny Sumrall,
More informationNew Aspects in the Diagnosis and Treatment of Atrial Fibrillation: Antithrombotic Therapy
New Aspects in the Diagnosis and Treatment of Atrial Fibrillation: Antithrombotic Therapy Hans-Christoph Diener Department of Neurology and Stroke Center University Hospital Essen Germany Conflict of Interest
More informationStroke. 2012;43: ; originally published online August 2, 2012; doi: /STR.0b013e a
Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation : A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association
More informationAtrial Fibrillation. 2 nd Annual National Hospitalist Conference San Antonio, TX September 7, 2018
2 nd Annual National Hospitalist Conference San Antonio, TX September 7, 2018, MSc, FACP, SFHM Division of Hospital Medicine Henry Ford Hospital Detroit, USA Clinical Associate Professor of Medicine Wayne
More informationDebate: New Generation Anti-Coagulation Agents are a Better Choice than Warfarin in the Management of AF
Debate: New Generation Anti-Coagulation Agents are a Better Choice than Warfarin in the Management of AF Bradley P. Knight, MD Director of Cardiac Electrophysiology Bluhm Cardiovascular Institute Northwestern
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 informationAF stroke prevention in the Canadian context
AF stroke prevention in the Canadian context 5 th Annual State of the Heart Toronto, May 31, 2014 Andrew C.T. Ha, MD, MSc, FRCPC Cardiac Electrophysiology Toronto General Hospital, University Health Network
More informationDIRECT ORAL ANTICOAGULANTS
2017 Cardiovascular Symposium DIRECT ORAL ANTICOAGULANTS ERNESTO UMAÑA, MD, FACC ORAL ANTICOAGULANTS Vitamin K Antagonists (VKAs): Warfarin Non Vitamin K Antagonists Direct oral anticoagulants Novel Oral
More informationLessons from recent antithrombotic studies and trials in atrial fibrillation
Lessons from recent antithrombotic studies and trials in atrial fibrillation Thromboembolism cause of stroke in AF Lars Wallentin Uppsala Clinical Research Centre (UCR) Uppsala Disclosures for Lars Wallentin
More informationAtrial Fibrillation: Risk Stratification and Treatment New Cardiovascular Horizons St. Louis September 19, 2015
Atrial Fibrillation: Risk Stratification and Treatment New Cardiovascular Horizons St. Louis September 19, 2015 Christopher E. Bauer, MD, FACC, FHRS SSM Health Heart & Vascular Care Clinical Cardiac Electrophysiology
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 informationSecondary Preven-on of Thromboembolic Stroke: Clinical Data and Recommenda-ons from the ESC Atrial Fibrilla-on Guideline Update 2012
Secondary Preven-on of Thromboembolic Stroke: Clinical Data and Recommenda-ons from the ESC Atrial Fibrilla-on Guideline Update 2012 Professor Dan Atar Head, Dept. of Cardiology Councillor of the ESC,
More informationUpdates in Stroke Management. Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy
Updates in Stroke Management Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy Disclosure I have no actual or potential conflict of interest
More informationObjectives for Technicians. Objectives for Pharmacists. Pathophysiology. Conflict of Interest. Atrial Fibrillation
Warfar IN or Warfar-OUT? And Other Updates in the Management of Atrial Fibrillation Kimberly Ackerbauer, PharmD, BCPS Clinical Pharmacy Specialist Rush University Medical Center Conflict of Interest I
More informationIndividual Therapeutic Selection Of Anti-coagulants And Periprocedural. Miguel Valderrábano, MD
Individual Therapeutic Selection Of Anti-coagulants And Periprocedural Management Miguel Valderrábano, MD Outline Does the patient need anticoagulation? Review of clinical evidence for each anticoagulant
More informationNOAs for stroke prevention in Atrial Fibrillation: potential advantages in the elderly patients. Giancarlo Agnelli
NOAs for stroke prevention in Atrial Fibrillation: potential advantages in the elderly patients Giancarlo Agnelli Internal & Cardiovascular Medicine - Stroke Unit University of Perugia, Italy My talk today
More informationAtrial Fibrillation. Alan Bell, MD, CCFP. Staff Physician, Humber River Regional Hospital. University of Toronto
Pearls in Thrombosis 1 Atrial Fibrillation Alan Bell, MD, CCFP Staff Physician, Humber River Regional Hospital Assistant tprofessor, Department tof Family and Community Mdii Medicine University of Toronto
More informationAbstract. Introduction. imedpub Journals Doson Chua* Research Article. Cardiovascular Investigations: Open Access
Research Article imedpub Journals www.imedpub.com Cardiovascular Investigations: Open Access Vol. 2 No.1: 1 Use of Non-vitamin K Antagonist Oral Anticoagulants (NOAC) for Stroke Prevention in Patients
More informationANTITHROMBOTIC THERAPY IN CARDIOLOGY. Sokratis Pastromas, MD
HOSPITAL CHRONICLES 2012, VOLUME 7, SUPPLEMENT 1: 54 60 ANTITHROMBOTIC THERAPY IN CARDIOLOGY Newer Anticoagulants for Atrial Fibrillation: the Role of Dabigatran, Rivaroxaban, Apixaban and Edoxaban / RELY,
More informationIS THERE STILL A PLACE FOR VITAMINE K ANTAGONISTS?
IS THERE STILL A PLACE FOR VITAMINE K ANTAGONISTS? J.Y. LE HEUZEY Georges Pompidou Hospital, René Descartes University, Paris H E G P Munich, August 27, 2012 Disclosure Consultant / Conferences / Advisory
More informationResults from RE-LY and RELY-ABLE
Results from RE-LY and RELY-ABLE Assessment of the safety and efficacy of dabigatran etexilate (Pradaxa ) in longterm stroke prevention EXECUTIVE SUMMARY Dabigatran etexilate (Pradaxa ) has shown a consistent
More informationΣεμινάπιο Ομάδων Δπγαζίαρ ΟΜΑΓΑ ΔΡΓΑΣΙΑΣ ΗΛΔΚΤΡΟΦΥΣΙΟΛΟΓΙΑΣ ΚΑΙ ΒΗΜΑΤΟΓΟΤΗΣΗΣ Κολπική μαπμαπςγή
Σεμινάπιο Ομάδων Δπγαζίαρ ΟΜΑΓΑ ΔΡΓΑΣΙΑΣ ΗΛΔΚΤΡΟΦΥΣΙΟΛΟΓΙΑΣ ΚΑΙ ΒΗΜΑΤΟΓΟΤΗΣΗΣ Κολπική μαπμαπςγή Δξελίξειρ ζηην ανηιπηκηική αγωγή ζε αζθενείρ με κολπική μαπμαπςγή Ξςδώναρ Σωηήπιορ Μονάδα Δμθπαγμάηων και
More informationPrepared by Pfizer-BMS alliance in response to an unsolicited request Not for further distribution
Prepared by Pfizer-BMS alliance in response to an unsolicited request Not for further distribution AF review Petr Polasek Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document
More informationAF review. Petr Polasek
AF review Petr Polasek Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic, electronic,
More informationAnticoagulation Beyond Coumadin
Anticoagulation Beyond Coumadin Saturday, September 21, 2013 Crystal Mountain Resort and Spa Pratik Bhattacharya MD, MPH Stroke Neurologist, Michigan Stroke Network; Assistant Professor of Neurology; Wayne
More informationcontroversies in anticoagulation: optimizing outcome for atrial fibrillation
controversies in anticoagulation: optimizing outcome for atrial fibrillation SUNDAY, NOVEMBER 13, 2016 WESTIN HOTEL NEW ORLEANS CANAL PLACE COLLABORATE INVESTIGATE EDUCATE PROVIDING PERSPECTIVE: CURRENT
More informationACCP Cardiology PRN Journal Club
ACCP Cardiology PRN Journal Club 1 Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease Cody A. Carson, PharmD, BCPS PGY2 Cardiology Pharmacy Resident
More informationPRESENTATION TITLE. Case Studies
PRESENTATION TITLE Case Studies 1) SH is a 67 year old male. He has a history of type 2 diabetes, controlled hypertension and peripheral artery disease. He takes naproxen 500mg bd for arthritis and admits
More information2 Jean-Pierre Baeyens European Union Geriatric Medicine Society (EUGMS) representative
26 June 2014 Committee for Medicinal Products for Human Use (CHMP) Overview of comments received on 'Guideline on clinical investigation of medicinal products for prevention of stroke and systemic embolic
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 informationTSHP 2014 Annual Seminar 1
Debate: Versus the Rest of the World for Stroke Prevention in Non-valvular Atrial Fibrillation Matthew Wanat, PharmD, BCPS Clinical Assistant Professor University of Houston College of Pharmacy Clinical
More informationANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION Colin Edwards Auckland Heart Group Waitemata Health June 2015 PFIZER Lecture series Disclosures EPIDEMIOLOGY Atrial fibrillation is the most
More informationAntithrombotics in the elderly. Robert Gabor Kiss FESC FACC Budapest
Antithrombotics in the elderly Robert Gabor Kiss FESC FACC Budapest The patient in the elderly You are sitting in Your office prescribing drugs and observing outcome The black box from prescription to
More informationIs Apixaban Effective for the Prevention of Stroke in Patients With Non-Valvular Atrial Fibrillation?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2014 Is Apixaban Effective for the Prevention
More informationReview Article. Korean Circulation Journal
Review Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal The Korean Heart Rhythm Society s 2014 Statement on Antithrombotic Therapy for Patients with Nonvalvular Atrial Fibrillation:
More informationNOAC vs. Warfarin in AF Catheter Ablation
KHRS 2013 2013-Jun-15 NOAC vs. Warfarin in AF Catheter Ablation Jin-Seok Kim, MD Department of Cardiology Sejong General Hospital Bucheon, Republic of Korea Clinical Burden of AF Rhythm Disturbance Thromboembolic
More informationSupplementary Online Content
Supplementary Online Content Huang W-Y, Singer DE, Wu Y-L, et al. Association of intracranial hemorrhage risk with non vitamin K antagonist oral anticoagulant use vs aspirin use: a systematic review and
More informationFor more than 50 years, warfarin was the sole oral
Prescribing Patterns of Novel Anticoagulants Within a Statewide Multispecialty Practice At a Glance Practical Implications p 98 Author Information p 102 Full text and PDF www.ajpb.com Original Research
More informationDavis, LL. (2013) Preventing stroke in patients with atrial fibrillation. The Nurse Practitioner, 38(11):
Preventing stroke in patients with atrial fibrillation By: Leslie L. Davis Davis, LL. (2013) Preventing stroke in patients with atrial fibrillation. The Nurse Practitioner, 38(11): 24-31. This is a non-final
More informationEvaluate Risk of Stroke & Bleeding in AF Patients
XV World Congress of Arrhythmias, Beijing, China - 17-20 September, 2015 Evaluate Risk of Stroke & Bleeding in AF Patients Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation
More informationEdoxaban in Atrial Fibrillation
Edoxaban in Atrial Fibrillation Glenn Gormley, MD, PhD Senior Executive Officer and Global Head of R&D, Daiichi Sankyo Co., Ltd Nov. 4, 2014 Tuesday Background Based on the results of ENGAGE AF-TIMI 48,
More informationA Patient Unsuitable for VKA Treatment
Will Apixaban change practice in atrial fibrillation? A Patient Unsuitable for VKA Treatment Professor Yoseph Rozenman The E. Wolfson Medical Center Jerusalem June 2013 Disclosures I have the following
More informationDirect oral anticoagulant use and the incidence of bleeding in the very elderly with atrial fibrillation
J Thromb Thrombolysis (2016) 42:573 578 DOI 10.1007/s19-016-1410-z Direct oral anticoagulant use and the incidence of in the very elderly with atrial fibrillation Fatima Khan 1,2 Hans Huang 2 Yvonne H.
More informationInitial assessment of patient with AF in primary care DR BRUCE TAYLOR GPwSI Cardiology SCN Merseyside and Cheshire Clinical Lead Primary care
Initial assessment of patient with AF in primary care DR BRUCE TAYLOR GPwSI Cardiology SCN Merseyside and Cheshire Clinical Lead Primary care 11 th and 25 th September 2014 3 KEY OBJECTIVES OF TALK 1.
More informationThe New Drugs: Are They Worth It? A PHARMACOECONOMIC PERSPECTIVE
The New Drugs: Are They Worth It? A PHARMACOECONOMIC PERSPECTIVE Niteesh K. Choudhry, MD, PhD Associate Professor, Harvard Medical School Associate Physician, Division of Pharmacoepidemiology and Pharmacoeconomics,
More informationAntithrombotic therapy: triple therapy or triple threat?
THE NEW ERA IN ANTITHROMBOTIC THERAPY Antithrombotic therapy: triple therapy or triple threat? Jessica Mega 1 and Edward T. Carreras 1 1 Brigham and Women s Hospital and Harvard Medical School, Boston,
More informationCost and Prevalence of A fib. Atrial Fibrillation: Guideline Directed Treatment. Prevalence of A Fib. Risk Factors for A Fib. Risk Factors for A Fib
Atrial Fibrillation: Guideline Directed Treatment Melissa Wendell, FNP-C, MSN Heart Failure - Lead Nurse Practitioner, Aspirus Wausau Hospital and Aspirus Cardiology Cost and Prevalence of A fib 33.5 million
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 informationIs There a Role For Pharmacokinetic/ Pharmacodynamics Guided Dosing For Novel Anticoagulants? Christopher Granger
Is There a Role For Pharmacokinetic/ Pharmacodynamics Guided Dosing For Novel Anticoagulants? Christopher Granger 1 Disclosures Research contracts: Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim,
More informationNOAC trials for AF: A review
NOAC trials for AF: A review Chern-En Chiang, MD, PhD, FACC, FESC General Clinical Research Center Division of Cardiology Taipei Veterans General Hospital National Yang-Ming University Taipei, Taiwan Presenter
More informationFINAL CDEC RECOMMENDATION
FINAL CDEC RECOMMENDATION APIXABAN (Eliquis Bristol-Myers Squibb Canada and Pfizer Canada Inc.) New Indication: Prevention of Stroke and Systemic Embolism in Patients with Atrial Fibrillation Recommendation:
More information:{ic0fp'16. Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines. (and the Evidence for When to Stray) Kevin Overbeck, DO
:{ic0fp'16 ACOFP 53 rd Annual Convention & Scientific Seminars Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines (and the Evidence for When to Stray) Kevin Overbeck, DO Optimal Heart Health
More informationIncidence and Impact of Antithrombotic-related Intracerebral Hemorrhage
Incidence and Impact of Antithrombotic-related Intracerebral Hemorrhage John J. Lewin III, PharmD, MBA, BCCCP, FASHP, FCCM, FNCS Division Director, Critical Care & Surgery Pharmacy Services, The Johns
More informationApixaban for Atrial Fibrillation in Patients with End-Stage Renal Disease on Dialysis
Apixaban for Atrial Fibrillation in Patients with End-Stage Renal Disease on Dialysis Caitlin Reedholm, PharmD PGY1 Pharmacy Resident St. David s South Austin Medical Center November 2, 2018 Abbreviations
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised
Name: generic (trade) Dabigatran etexilate (Pradaxa ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised Direct thrombin inhibitor
More informationDefining Sub-Clinical Atrial Fibrillation and its management
Defining Sub-Clinical Atrial Fibrillation and its management Jeff Healey MD, MSc, FRCP, FHRS PHRI Chair in Cardiology Research Population Health Research Institute McMaster University, Canada Sub-Clinical
More informationScoring Systems in AF 8/10/2016. Strategies in the Prevention of Atrial Fibrillation-Related Strokes. Overview
Strategies in the Prevention of Atrial Fibrillation-Related Strokes Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania September
More informationWHY? AF Increases Stroke Risk by Nearly 500% Disclosures. Terminology. Anticoagulation in Atrial Fibrillation: Why, What, When and for How Long
Anticoagulation in Atrial Fibrillation: Disclosures Why, What, When and for How Long Edward Kersh, MD, FACC Chief of Cardiology, St. Luke s Hospital, SF Clinical Professor of Medicine, UCSF CAPA, September
More informationAtrial fibrillation (AF) is the most common sustained
New Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation At a Glance Practical Implications p 270 Author Information p 281 Full text and PDF www.ajpblive.com Review Article Daniel E. Hilleman,
More informationAnticoagulant therapy, coumadines or direct antithrombins
ATRIAL FIBRILLATION (AF) Anticoagulant therapy, coumadines or direct antithrombins Felicita Andreotti, MD PhD Aggregated Professor Dept of Cardiovascular Sciences, Catholic University, Rome, IT Consultant
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 informationStratificazione del rischio, corretto bilancio tra ischemia e bleeding: il beneficio clinico netto
Fibrillazione atriale: rischio tromboembolico, Venezia - 27/28 Novembre 2015 Stratificazione del rischio, corretto bilancio tra ischemia e bleeding: il beneficio clinico netto Antonio Raviele, MD, FESC,
More informationADVANCES IN ANTICOAGULATION
ADVANCES IN ANTICOAGULATION The Clinicians Perspective Claudine M. Lewis Cardiologist OUTLINE Indications for anticoagulants Review - Physiology of Hemostasis Types of anticoagulants New anticoagulants
More informationStroke prevention, Clinical trials
Received: 13 May 2016 Revised: 8 August 2016 Accepted: 18 August 2016 DOI 10.1002/clc.22596 REVIEWS Special considerations for therapeutic choice of non vitamin K antagonist oral anticoagulants for Japanese
More informationStudy period Total sample size (% women) 899 (37.7%) Warfarin Aspirin
Table S2 Sex- specific differences in oral anticoagulant prescription for stroke prevention in AF Total sample size (% women) Anticoagulant(s) studied Gage (2000) 1 Missouri, USA Discharged during 597
More informationPCI in Patients with AF Optimizing Oral Anticoagulation Regimen
PCI in Patients with AF Optimizing Oral Anticoagulation Regimen Walid I. Saliba, MD Director, Atrial Fibrillation Center Heart and Vascular Institute Cleveland Clinic 1 Epidemiology and AF and PCI AF and
More informationAtrial fibrillation and anticoagulation JIR-PING BOEY, DEPARTMENT OF HAEMATOLOGY, FLINDERS MEDICAL CENTRE FEBRUARY 2016
1 Atrial fibrillation and anticoagulation JIR-PING BOEY, DEPARTMENT OF HAEMATOLOGY, FLINDERS MEDICAL CENTRE FEBRUARY 2016 Disclosures 2 No conflicts of interest Some questions 3 Should my patient with
More informationUtilizing Anticoagulants for Atrial Fibrillation Related Stroke Prevention
Utilizing Anticoagulants for Atrial Fibrillation Related Stroke Prevention Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania
More informationRate or Rhythm Control? Epidemiology. Relevant Advances in Atrial Fibrillation 6/20/2011. Stroke Prophylaxis
Relevant Advances in Atrial Fibrillation Stroke Prophylaxis Managing Atrial Fibrillation: Tips for the Generalist Antiarrhythmic Drug Therapy Ablation Gregory M Marcus, MD, MAS Assistant Professor of Medicine
More informationStable CAD, Elective Stenting and AFib
Stable CAD, Elective Stenting and AFib Kurt Huber, MD, FESC, FACC, FAHA 3 rd Medical Department Cardiology & Intensive Care Medicine Wilhelminenhospital & Sigmund Freud Private University, Medical School
More informationGuiding Secondary Stroke Prevention through Evaluation of Ischemic Stroke Etiology
Guiding Secondary Stroke Prevention through Evaluation of Ischemic Stroke Etiology Ann M. Leonhardt Caprio, MS, RN, ANP-BC Program Coordinator Comprehensive Stroke Center, Strong Memorial Hospital Clinical
More informationOld and New Anticoagulants For Stroke Prevention Benefits and Risks
Old and New Anticoagulants For Stroke Prevention Benefits and Risks September 15, 2014 Jonathan L. Halperin, M.D. The Cardiovascular Institute Mount Sinai Medical Center Disclosure Relationships with Industry
More informationDirect Oral Anticoagulants (DOACs). Dr GM Benson Director NI Haemophilia Comprehensive Care Centre and Thrombosis Unit BHSCT
Direct Oral Anticoagulants (DOACs). Dr GM Benson Director NI Haemophilia Comprehensive Care Centre and Thrombosis Unit BHSCT OAC WARFARIN Gold standard DABIGATRAN RIVAROXABAN APIXABAN EDOXABAN BETRIXABAN
More informationNOACs in AF. Dr Colin Edwards Auckland Heart Group and Waitemata DHB. Dr Fiona Stewart Auckland Heart Group and Auckland DHB
NOACs in AF Dr Colin Edwards Auckland Heart Group and Waitemata DHB Dr Fiona Stewart Auckland Heart Group and Auckland DHB Conflict of Interest Dr Fiona Stewart received funding from Pfizer to attend the
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 informationFACTOR Xa AND PAR-1 BLOCKER : ATLAS-2, APPRAISE-2 & TRACER TRIALS
New Horizons In Atherothrombosis Treatment 2012 순환기춘계학술대회 FACTOR Xa AND PAR-1 BLOCKER : ATLAS-2, APPRAISE-2 & TRACER TRIALS Division of Cardiology, Jeonbuk National University Medical School Jei Keon Chae,
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 informationRETROSPECTIVE CLAIMS DATABASE STUDIES OF DIRECT ORAL ANTICOAGULANTS (DOACS) FOR STROKE PREVENTION IN NONVALVULAR ATRIAL FIBRILLATION
RETROSPECTIVE CLAIMS DATABASE STUDIES OF DIRECT ORAL ANTICOAGULANTS (DOACS) FOR STROKE PREVENTION IN NONVALVULAR ATRIAL FIBRILLATION Craig I. Coleman, PharmD Professor, University of Connecticut School
More informationEvidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation
Evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation Report of the Guideline Development Subcommittee of the American Academy of Neurology 1. Antonio Culebras, MD, FAAN,
More informationTroponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy. Ziad Hijazi, MD
Troponin I elevation increases the risk of death and stroke in patients with atrial fibrillation a RE-LY substudy Ziad Hijazi, MD Uppsala Clinical Research Center (UCR) Uppsala University, Sweden Co-authors:
More information3/23/2017. Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate Europace Oct;14(10): Epub 2012 Aug 24.
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationWeighing the risk of stroke vs the risk of bleeding: Which AF patients should be anticoagulated?
Weighing the risk of stroke vs the risk of bleeding: Which AF patients should be anticoagulated? Albert L. Waldo, MD, PhD (Hon) The Walter H. Pritchard Professor of Cardiology, Professor of Medicine,and
More information