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Managing Anticoagulation Interruptions

Managing Anticoagulation Interruptions | Heart and Vascular Health | Scoop.it

On the ClotBlog with Dr. Samuel Z. Goldhaber, at theheart.org on Medscape speaking to you from the American College of Cardiology Scientific Symposium in Washington, DC. Today, I have a special guest and a special friend, Dr. Seth Bilazarian. Seth, welcome to the ClotBlog.

Today I wanted to discuss with you a problem that you and I get calls and emails about over and over again, and that is how to safely interrupt anticoagulation. There are several different levels that we can quickly talk about, including cataract surgery and colonoscopy, but then we can go into the more nitty gritty area of what do we do with patients who have mechanical heart valves. Let's start with cataract surgery. Do you ever instruct your patients to interrupt their anticoagulation?

Seth Bilazarian, MD's insight:

Discussion between a leading academic on thrombosis (Dr Goldhaber) and a community based practitioner (me) on the complexity of managing anti-coagulation around the time of a procedure or surgery.

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Thanks for the great plug on twitter : John Mandrola, MD ‏@drjohnm 

Grt discussion on interrupting anticoagulation w/@DrSethdb & Dr Goldhaber http://www.medscape.com/viewarticle/824855?utm_source=twitterfeed&utm_medium=twitter&nbsp;… < Like this topic b/c #judgement critical.

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Novel Oral Anticoagulant transitions

Novel Oral Anticoagulant transitions | Heart and Vascular Health | Scoop.it

In my clinical practice, this is one of the most frequent things that I am asked to address -- whether it is dual antiplatelet therapy, stopping antiplatelet therapy in general, or stopping anticoagulants and adopting NOACs. It has been a challenge, but we have pretty good data to help guide decisions about NOACs, and this has been extensively covered.

But the issue about NOAC transitions is that we don't have a lot of data. It is uncharted territory. Making sense of NOAC transitions is something that I am trying to address for myself and sharing here in this blog to you as the "co-pupil" or "co-traveler" in this difficult area.

Seth Bilazarian, MD's insight:

My attempt to manage the topic of transitions with novel oral anti-coagulants (Pradaxa, Xarelto, Eliquis) - stiopping, starting, holding these agents for procedures. Interested in other physicians insights on this topic.

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Eliquis: New Medication for Atrial Fibrillation

An in-depth conversation between Pentucket Medical cardiologists Seth Bilazarian and Sunny Srivastava, focusing on a newly released medicine to reduce the risks of atrial fibrillation. The latest among recently approved blood thinners, Eliquis joins Pradaxa and Xarelto as an alternative to Coumadin, a drug that has been in use since the 1950s. Like Pradaxa and Xarelto, Eliquis has been shown to reduce risk of stroke and bleeding, as well as mortality. All the new drugs eliminate the need for regular blood testing that Coumadin necessitates.

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Xarelto (rivaroxaban) approved for stroke prevention in atrial fibrillation 2 years ago

Xarelto (rivaroxaban) approved for stroke prevention in atrial fibrillation 2 years ago | Heart and Vascular Health | Scoop.it

#OnThisDay (11/4/2011) two years ago the first Factor Xa inhibitor and second novel oral anticoagulant (NOAC) was approved to prevent stroke in atrial fibrillation.  We now have three NOACs available.

Seth Bilazarian, MD's insight:

There are now three NOACs available as an alternative to warfarin (coumadin) and one on the horizon in 2014.   The uptake in the US has been slow.  Xarelto is the only one of the NOACs that has been approved for other indications such as DVT's (clots in the leg), PE (clots in the lung), or the prevention of these problems after knee and hip surgery. Physician and patient familairity and comfort with these new options is slowly growing.

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What to do about bridging with novel oral anticoagulants

What to do about bridging with novel oral anticoagulants | Heart and Vascular Health | Scoop.it
Sharing a rare moment of person-to-person time during the scientific sessions in San Francisco, Dr Seth Bilazarian asks Drs Samuel Goldhaber how he goes about bridging with dabigatran, rivaroxaban, and apixaban.
Seth Bilazarian, MD's insight:

All of the new blood thinners or novel oral anticoagulants (NOAC)  have a warning in their label about the hazard of stopping them. These agents have a short half life so within 1 - 2 days they are out of the system and there is no blood thinner protection from the hazard of atrial fibrillation (AF).  Should patients going for procedures receive "bridging" with intravenous (IV) blood thinners to protect them during the interval off these new agents.  Perspective from Sam Goldhaber of the Clot Blog on theheart.org.

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It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines

It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines | Heart and Vascular Health | Scoop.it

The new oral anticoagulants (NOAC): dabigatran (Pradaxa) and rivaroxaban (Xarelto), both FDA approved, and apixaban (Eliquis), which has not been approved, can all be considered for stroke prevention in nonvalvular atrial fibrillation, a science advisory from AHA/ ASA stated.

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