1 / 9

NOVEL ANTICOAGULANTS

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

jana
Télécharger la présentation

NOVEL ANTICOAGULANTS

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NOVEL ANTICOAGULANTS Vladimir Bogin, MD October 5, 2008

  2. Agenda • Review Disease States • Review Current Treatment Options • Review Novel Anticoagulants

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Thank you

More Related