The optimal antithrombotic regimen in patients with AF and comorbid CAD remains unclear. Current American College of Cardiology/American Heart Association guidelines provide minimal guidance on whether to continue antiplatelet therapy in combination with anticoagulation in this population. Additionally, while the 2017 European Society of Cardiology guidelines recommend oral anticoagulation alone, there is little supporting evidence for this recommendation. This blog discusses the implications of the recently published AFIRE study, which attempts to answer the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?
Should DOACs be Used for Treatment of Cancer-Related Thromboembolism?
Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Until recently, low molecular weight heparins (LMWH) were generally the preferred therapeutic class for treatment of VTE in patients with cancer. However, LMWH use is limited in the outpatient setting by parenteral administration. Recently, direct oral anticoagulants (DOACs) have demonstrated efficacy in large randomized clinical trials of patients with both VTE and atrial fibrillation and are recommended over warfarin in certain populations. Given the attractive oral dosing option and lack of laboratory montioring, DOAC use have been used for VTE treatment for patients with cancer. In this blog, we summarize the available trial data and provide clinical recommendations for VTE treatment in patients with cancer.
3 Things You Should Know Before Throwing in the Towel on Triple Therapy
When it comes to triple therapy, the totality of the evidence strongly suggests “less is more”. While many practitioners have been quick to adopt dual antithrombotic therapy, it is important to consider the external validity of these trials and how we apply them to our patients. In this blog, Dr. Noel offers 3 considerations that require careful reflection before throwing in the towel on triple therapy.
AC in ESRD (Part III): Warfarin Over Apixaban for Patients with Atrial Fibrillation and End Stage Renal Disease
Part III of this three part series focuses on the role of warfarin in end stage renal disease (ESRD). Is it time to retire warfarin for anticoagulation in patients with ESRD and atrial fibrillation (AF)? Are there supporting data for warfarin in patients with ESRD? How does it compare to apixaban? Check out the blog for full details and answers to these questions.
AC in ESRD (Part II): Apixaban Over Warfarin for Patients with Atrial Fibrillation and End Stage Renal Disease
Part II of this three part series focuses on apixaban in end stage renal disease. Is it safe? How does it compare to warfarin? What dose should you use? Check out the blog for full details and answers to these questions.
AC in ESRD (Part 1): First, Do No Harm – No Anticoagulation in Patients with End Stage Renal Disease and Atrial Fibrillation
Selecting the best anticoagulation strategy for patients with end stage renal disease and atrial fibrillation remains controversial. In this three part series, we will explore potential strategies that seek to balance the risk of stroke with adverse effects in patients with end stage renal disease and atrial fibrillation. In Part 1 of this series, we will discuss the risks of anticoagulation and provide a compelling argument for avoiding anticoagulation. The role of direct oral anticoagulants and warfarin in this patient population will be reviewed in Parts 2 and 3, respectively.
Post-TAVR Antithrombotic Therapy: What To Do When No One Knows What To Do.
Transcatheter aortic valve replacement (TAVR) has proven to be an effective treatment option for patients with severe aortic stenosis at intermediate-high risk for complications with surgical aortic valve replacement. In spite of the growing popularity of TAVR, the optimal antithrombotic regimen remains unknown. This blog outlines current guideline recommendations for post-TAVR antithrombotic therapy and gives guidance on how to handle special populations and patient-specific factors.
Treat the Patient, Not the Number: Stroke Prevention in Atrial Fibrillation with Low CHA2DS2-VASc Scores
Although guidelines for the management of atrial fibrillation advocate for anticoagulation in patients with a high stroke risk (CHA2DS2-VASc score of 2 or greater), the recommendations for patients at low (CHA2DS2-VASc 0) and in particular intermediate (CHA2DS2-VASc 1) risk of stroke are less clear. In this blog, we discuss antithrombotic strategies in these latter two subgroups.
Anticoagulation Safety (Part 2 of 2): The Role of an Anticoagulation Stewardship Pharmacist
Anticoagulants account for 5-10% of drug errors that occur in the hospital. Part 2 of this 2-part series on anticoagulation safety will focus on the role of anticoagulation stewardship, including what it entails, who is involved, and why it is important.
Anticoagulation Safety (Part 1 of 2): Common Drug Errors with NOACs… I Mean DOACs!
Anticoagulants are some of the most commonly implicated drugs in emergency department visits and hospitalizations due to adverse drug events. Medication errors can significantly influence these events, and pharmacists are at the forefront for preventing medication errors from reaching the patient. Part 1 of this 2 part series on anticoagulation safety will focus on common medication errors involving direct oral anticoagulants. Part 2 will focus on ways pharmacists can help prevent medication errors with anticoagulants, particularly as it relates to anticoagulation stewardship programs.