Novel anticoagulants
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NOVEL ANTICOAGULANTS. Vladimir Bogin, MD October 5, 2008. Agenda. Review Disease States Review Current Treatment Options Review Novel Anticoagulants. Anticoagulation: Who and When. Venous thromboembolism DVT and PE (Rx and prophylaxis) Arterial thromboembolism

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NOVEL ANTICOAGULANTS

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Novel anticoagulants

NOVEL ANTICOAGULANTS

Vladimir Bogin, MD

October 5, 2008


Agenda

Agenda

  • Review Disease States

  • Review Current Treatment Options

  • Review Novel Anticoagulants


Anticoagulation who and when

Anticoagulation: Who and When

  • Venous thromboembolism

    • DVT and PE (Rx and prophylaxis)

  • Arterial thromboembolism

    • Atrial Fibrillation/Flutter

    • Prosthetic mechanical valves

    • Severe CHF

    • Pulmonary hypertension

    • AV fistulas

      * Acute coronary syndromes


Vladimir bogin

  • Venous thromboembolism

    Prophylaxis:

    • post-surgery, medically ill, oncolological patients

    • Lovenox, Fondoparinox, SQ Heparin, Warfarin for 12-21 days

      Treatment

    • “Provoked” (i.e LE surgery, fractures)

      • Warfarin for 3-6 months with initial “bridging”

    • “Unprovoked”

      • 12 months of Warfarin (Lovenox for oncological patients)

      • Lifelong in hypercoagulable states

        • Factor V Leiden, Hyperhomocysteinemia, factor VIII mutations


Vladimir bogin

Arterial thromboembolism

  • Atrial fibrillation – lifelong anticoagulation (INR 2-3)

    • CHADS2 score>1

    • Only 50-60% of eligible patients are anticoagulated

  • Prosthetic mechanical valves (INR2.5-3.5)

  • CHF: usually EF<15%, history of embolic events, LV thrombus

  • Pulmonary hypertension


Treatment options

Treatment Options

  • Warfarin

    • 57 years on the market

    • “Rat poison”

    • Monitoring is a nightmare, multiple drug and food interactions

  • Lovenox (ATIII and factor Xa)

  • Fondaparinox (Arixtra) – indirect Xa inhibitor

  • Direct Thrombin Inhibitors

    • Argatroban, Bivalirudin (Angiomax), Hirudin

      • Usually in HIT, ACS

  • IIb/IIIa inhibitors (i,.e Reopro, Integrelin, Aggrostat)

    • Only in ACS


Novel oral anticoagulants

Novel Oral Anticoagulants

  • Rivaroxaban (Xalerto) – factor Xa inhibitor

    • Approved for DVT prophylaxis in Europe

  • Dabigatran (Pradaxa) – Direct thrombin Inhibitor

    • On the market in Europe and in Canada

  • Apixaban - factor Xa inhibitor

  • Advantages:

    • No monitoring required

    • No food or drug interaction

    • Rapid onset of action and short half-life


Us af registry timelines

US AF Registry: Timelines

US AFib registry

enrollment starts

US AFib registry

study complete

US AFib registry

enrollment ends

Pradaxa AFib

Launch

Q3

Q4

2009

Q2

Q3

Q4

2010

Q2

Q3

Q4

  • Approvals

  • US

  • Corp

Initiate publications

Publications at

US Congresses

Interim publications

Identify Advisory Panel

Develop protocol

Identify CRO


Vladimir bogin

Thank you


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