Synergy Satellite: Anticoagulants – a matter of heart! Towards a bright future?

ACPE UPN: 0475-0000-14-004-L04-P. A knowledge based activity.

Abstract

The introduction of novel oral anticoagulants, e.g. dabigatran, rivaroxaban, and apixaban, into clinical practice challenge well established concepts of anticoagulation pharmacotherapy, such as low molecular weight heparins and vitamin k antagonists.

Therapeutic management using coumarins, for example, is complicated. Efficacy is, among others, influenced by diet, drug-drug interactions and genetic polymorphisms. Frequent monitoring is necessary and time consuming. Hospital pharmacists have always focused on this drug class, as it is associated with a high risk of drug-related problems and medication errors. The results of clinical landmark trials with these novel drugs and ongoing research will undoubtedly lead to changes in the use of vitamin K antagonists and significantly influence the pharmacotherapy of relevant cardiovascular diseases.

These novel drugs unquestionably come with advantages. However, hospital pharmacists have to be aware of uncertainties (e.g. mode of reversal of anticoagulation, long-term safety data) and of the limitations (e.g. adherence) of these novel anticoagulants.

These anticoagulants are promising alternatives, but their widespread use in everyday clinical practice leave questions that still need to be answered. How will the safety record of these novel drugs compare to that of half-a-century safety data of Warfarin? Will there still be a place for vitamin K antagonists in future anticoagulation? Is one newer agent superior to the others? Will drug costs be a hindering factor for treatment access?

As key stakeholders in assessing and selecting drugs for in-hospital use, hospital pharmacists need to acquire an in-depth knowledge of these novel anticoagulants, and be competent to comment on their safety and in addition contribute to patient education.

Teaching Goals:

• To illustrate clinical decision criteria how to choose among the available novel oral anticoagulants in terms of efficacy and safety,
• To present selected issues of patient education with regard to the available novel oral anticoagulants,
• To discuss novel oral anticoagulants in terms of value for money.

Learning Objectives

After the seminar the participants should be able to:

• to outline the most important educational aspects in daily practice with regard to the available novel oral anticoagulants,
• to describe key issues regarding cost-effectiveness of the available novel oral anticoagulants,
• to recall the most important efficacy and safety issues in order to distinguish among the available novel oral anticoagulants.