(Doacs) APIXABAN/DABIGATRAN/EDOXABAN/RIVAROXABAN

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MANAGEMENT PLAN FOLLOWING INITIATION OF DIRECT ORAL ANTICOAGULANTS (DOACs) APIXABAN/DABIGATRAN/EDOXABAN/RIVAROXABAN CONSIDERATIONS AT TIME OF INITIATION Confirm appropriateness of therapy Obtain baseline labs (CBC/LFTs/SCr) and calculate creatinine clearance (CrCl) using Cockcroft-Gault Conduct medication review to assess potential for drug interactions (see https://depts.washington.edu/anticoag) Review indication for therapy and provide education to patient, supplemented by written materials Apixaban for treatment of VTE: DOAC MONIITORING CHECKLIST change dose from 10mg bid (for 1 week ) to 5mg bid 1 1 Week Follow-Up FOR EACH FOLLOWUP VISIT Adherence (including Rx refills) Is patient experiencing Yes Take with food and full glass dyspepsia? of water Thromboembolic events Consider PPI or H2 blocker Bleeding events/risk factors Is patient experiencing Yes other adverse side effects? Treat any modifiable factors Adverse effects and/or consider switching to No another agent Medication review for potentially interacting drugs At 3 weeks Rivaroxaban for including ASA and NSAIDs (see treatment of VTE: change dose from https://depts.washington.edu/ 15mg bid (for 3 anticoag) weeks) to 20mg qday Reassessment of appropriateness and duration of therapy At 3 Months Repeat CBC Repeat SCR/Calculate CrCl Any sign of medication 1 intolerance? Clinical judgment should be used to At 6 months determine frequency of monitoring based on patient’s overall health, compliance, and risk factors Continuing Follow-up After 1st 6 Months 1. CrCl > 60 m/min: Checklist once yearly Any concerns? including annual LFTs 2. CrCl < 60 ml, age> 75, wt < 60kg or medically fragile: Checklist q6months and No Yes annual LFTs Continue routine scheduled Reassess risk vs benefit follow-up Adjust dose or switch to another anticoagulant Increase frequency of monitoring for patients with renal or hepatic impairment or at risk for worsening renal or hepatic function UW Medicine Anticoagulation Services June 2015 .

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Doacs) and the Antidote Idarucizumab
Update overview 2019 of reports on direct oral anticoagulants (DOACs) and the antidote idarucizumab Introduction Lareb previously published yearly overviews of reports (most recently in 2018) in consultation with the Medicines Evaluation Board CBG-MEB, concerning the direct oral anticoagulants (DOACs) dabigatran Pradaxa®, registered in the Netherlands in 2008 [1], rivaroxaban Xarelto®, registered in 2008 [2], apixaban Eliquis®, registered in 2011 [3] and edoxaban (Lixiana®), registered in 2015 [4-9]. The current overview provides a new yearly update of the reports received by Lareb for these DOACs. Furthermore, reports received by Lareb for the antidote idarucizumab are described in this overview. Idarucizumab is a specific antidote for dabigatran and was registered in the Netherlands in 2015 [10]. For this overview, data from the national ADR database were used. These data include reports with serious outcome from the Lareb Intensive Monitoring System (LIM). The DOACs have been monitored with the LIM methodology since September 2012. Prescription data The number of patients using DOACs in the Netherlands according to the GIP database is shown in table 1 [11]. These data are based on extramurally provided medication included in the Dutch health insurance package. Because the antidote idarucizumab is administered in the hospital and not reimbursed directly via the healthcare insurance, these data are not available for this drug. The number of reports received by the Netherlands Pharmacovigilance Centre Lareb per year since 2013 for each DOAC, is also shown in table 1. Furthermore, table 1 shows the calculated number of these reports per 1.000 users according to the GIP database. As noted before, the data from the GIP database represent reimbursed medicines and these may differ from actually prescribed medicines.
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Presentazione Standard Di Powerpoint
EVALUATION OF ADHERENCE TO NEW ORAL ANTICOAGULANTS THERAPY BASED ON THERAPEUTIC SWITCHES: A DESCRIPTIVE STUDY. L. Gasperoni1, F. Ambrosini Spinella1, A.M. Resta1. 1 ASUR Marche, Territorial Pharmaceutical Service AV1, Fano, Italy Abstract number: 5PSQ-011 ATC code: B01 - Antithrombotic agents Background Regarding therapeutic adherence to new oral ITALY: the prescription of NOAC is possible from anticoagulants (NOAC), several studies [1] have shown Dabigatram July 2013 lower adherence in Dabigatran treated patients compared to Rivaroxaban and Apixaban. The NOAC Rivaroxaban October 2013 introduction has fueled the phenomenon of switch Apixaban March 2014 from vitamin K antagonists (VKA) to NOAC, and vice Edoxaban October 2016 versa, and also from NOAC to other NOAC. Purpose The aim of this descriptive study is to evaluate adherence to therapy among NOAC treated patients by basing the analysis on the therapeutic switches, ie the passages to another NOAC or VKA. Material and methods Through the informatic flow of pharmaceutical prescriptions, we extracted the NOAC prescriptions from July 2013 to June 2016 in the Area Vasta 1 of the Region. Patients who have taken Dabigatran, Rivaroxaban and Apixaban have emerged from these prescriptions (Edoxaban is excluded because it is available since October 2016). Adherent patient was that who did not switch to other anticoagulant therapy (NOAC or VKA) during the analysis period and in the following 6 months (until December 2016). Patients who had taken VKA before starting treatment with NOAC (the flow of prescriptions was investigated since January 2013) and patients who died during the analysis period or in the following 6 months were excluded from the study.
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