novel anticoagulants n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
NOVEL ANTICOAGULANTS PowerPoint Presentation
Download Presentation
NOVEL ANTICOAGULANTS

Loading in 2 Seconds...

play fullscreen
1 / 9

NOVEL ANTICOAGULANTS - PowerPoint PPT Presentation


  • 1575 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'NOVEL ANTICOAGULANTS' - jana


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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

slide4
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
slide5
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