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Resource Center

Drug Therapy Management

Anticoagulation Discontinuation/Reversal

 Antithrombotic Reversal Guideline, UNMH, November 2015
5 page reversal guideline by specific agent, includes decision tree; approved by University of new Mexico Hospital Anticoagulation Subcommittee
 ASH Pocket Guide, 2014
2014 Clinical Practice Guide on Anticoagulant Dosing & Management in a quick reference format
 Management of Anticoagulation Therapy - Presentation from Chest Guidelines
25 page PowerPoint 9th edition of CHEST guidelines, 2012
 Reversal of DOACs
2012 chart with reversal of Apixaban, Dabigatran and Rivaroxaban
 Reversal of Oral Anticoagulants Associated Acute Intracranial (ICH) or Life Threatening Hemorrhage from San Fran VA Health Care System, 2016
Compact 2-page decision tree incuding Warfarin, Dabigatran, Rivaroxaban, Apixaban; includes Idarucizumab along with precautions and complications; January, 2016 from the VA, San Francisco

Anticoagulation Initiation

 Ambulatory Warfarin Protocol
guideline outlines the evidence for managing anticoagulation therapy with oral vitamin K antagonist (warfarin). Evidence is based on recommendations from the Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Clinical Practice Guidelines
 DOAC Comparison Chart for Dabigatran, Rivaroxaban & Apixaban
Comprehensive chart, May 2013 including Dabigatran, Rivaroxaban, Apixaban, outlining uses, dosing, drug interactions, monitoring, special considerations, transitions of care & relevant studies; from the San Francisco VA
 DOAC Guideline for Hospitalized Patients, 2013
 Guide to Managing Warfarin Theapy for Hospitalized Patients
UNM Warfarin Dosing guideline for inpatient care, includes drug & food interaction and inpatient warfarin dosing adjustment nomogram (for target INR 2-3)
 Guideline for Anticoagulation Initiation (Kaiser Permanente)
Independent institutional example for basic drug initiation,therapeutic range
 ISTH Recommendations for DOAC Patient Selection
 Management of Anticoagulation Therapy - Presentation from Chest Guidelines
25 page PowerPoint 9th edition of CHEST guidelines, 2012
 Novel oral anticoagulants in atrial fibrillation: which novel oral anticoagulant for which patient?
7 page 2014 article from Italian Federation of Cardiologooy, includes comparison charts by drug based on recent studies; Priscoa, Cencia,Silvestria,Ciucciarelli,Di Minno
 Pediatric Anticoag Guidelines from The Children's Hospital of Philadelphia, 2014
multiple guidelines including anticoagulation medication guidelines for management of pediatric blood clots/thromboembolic disorders created by The Children's Hospital of Philadelphia & Dr. Dr. Leslie Raffini, 2014; Heparin, Enoxaparin & Coumadin included
 Sample Warfarin Ambulatory Protocol
 Warfarin 10 mg Dose Initiation Nomogram
 Warfarin 5 mg Initiation Nomogram

Anticoagulation Maintenance

 Ambulatory Warfarin Protocol
guideline outlines the evidence for managing anticoagulation therapy with oral vitamin K antagonist (warfarin). Evidence is based on recommendations from the Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Clinical Practice Guidelines
 Can we increase interval of INR Testing? AC Forum Webinar, 2011
45 minute AC Forum Webinar covering article by Sam Shulman, MD, PhD,Sameer Parpia, MSc; Clare Stewart, MA; Lisa Rudd-Scott, RN, BScN; Jim A. Julian, MMath; and Mark Levine, MD, MSc; Nov 2011
 Can we increase interval of INR Testing? article from 2011; Dr. Sam Shulman, MD, PhD
Warfarin Dose Assessment Every 4 Weeks Vs.12 Weeks in Patients w/Stable International Normalized Ratios: A Randomized Trial concluding for patients receiving a stable dose of warfarin for at least 6 months, every-12-week dosing was noninferior to every-4-week dosing with respect to the percentage of time spent in the therapeutic INR range, and the prolonged dosing assessment interval seemed safe
 DOAC Drug & Food Interactions
PowerPoint presentation outlining Drug/Drug and Drug/Food Interactions with Direct Oral Anticoagulants; Sara R. Vazquez, PharmD, BCPS, CACP University of Utah Health Care Thrombosis Center
 Guideline for Anticoagulation Maintenance
Example of institution specific guideline from Kaiser Permanente Colorado(CPAAS) Guidelines & Protocols
 Monitoring LMWH During Pregnancy
2013 Chart from UW Medicine offering guidance for monitoring of LMWHs during 3rd trimester of pregnancy
 Sample Warfarin Ambulatory Protocol

Complications During Therapy

 Coumadin Work Flow
An alert system developed by Dean Health for drug interactions with warfarin. Electronically alerts the prescriber when the medication is added to the med list of a patient taking warfarin with integration into the EMR
 Guideline for Managing and Triage of Anticoagulation Therapy Problems
 HEMORR2HAGES Risk Assessment Tool
 Recommendations for Air Travel
Overview of how to prevent VTE during travel, and how to diagnose and treat VTE from Cleveland Clinic, Feb, 2011

Comprehensive Management of DOAC

 Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation    NEW
Journal of Internal Medicine, 2015; A. M. Shields & G. Y. H. Lip; Review of how to choose the right DOAC for patients with non-valvular AF; includes risk assessment, pharmacology considerations, a decision tree and case-based examples
 Clinical Practice Guideline on Use of Antithrombotics in NVAF July 2014    NEW
17 page guide outlining considerations in deciding between ASA, warfarin and various DOAC agents from UW Health, July 2014. Includes flow diagram that points providers in the direction of appropriate agents based on patient-specific information.
 DOAC Comparison Chart for Dabigatran, Rivaroxaban & Apixaban
Comprehensive chart, May 2013 including Dabigatran, Rivaroxaban, Apixaban, outlining uses, dosing, drug interactions, monitoring, special considerations, transitions of care & relevant studies; from the San Francisco VA
 DOAC Drug & Food Interactions
PowerPoint presentation outlining Drug/Drug and Drug/Food Interactions with Direct Oral Anticoagulants; Sara R. Vazquez, PharmD, BCPS, CACP University of Utah Health Care Thrombosis Center
 DOAC Drug Interaction Summary Page
Comprehensive summary including USA FDA, Canada and EMA guidelines for Dabigatran, Rivaroxaban and Apixaban, as of 7/2013,Sara R. Vazquez, PharmD, BCPS, CACP University of Utah Health Care Thrombosis Center
 DOAC Patient Selection ASH 2012
 DOAC Reversal, 2012
European Heart Journal; Crowther & Siegal,12/2012 reviews DOACs & summarizes published rates of major bleeding, use & limitations of coagulation testing,potential reversal agents,management of acute bleeding associated with use of DOACs
 European Heart Rhythm Association Practical Guide on use of DOACs in Non-Valvular AFIB
 Guidelines for Peri-Procedural Mgmt of Adults Taking dabigatran, rivaroxaban, apixaban, edoxaban, 2015
Guide developed by the VA of California,with bridging recommendations based on bleeding vs. thromboembolic risk; Margaret Fang, MD, Steven Kayser, PharmD, Tracy Minichiello, MD, Christina S. Wang, PharmD
 Management plan following initiation of Apixaban, Dabigatran, Edoxaban, Rivaroxaban    NEW
1 page decision tree from Univ of Washington, including checklist for each follow up visit and labs after initiation of a DOAC, January 2015
 Reversal of DOACs
2012 chart with reversal of Apixaban, Dabigatran and Rivaroxaban
 Reversal of target-specific oral anticoagulants Deborah M. Siegal, Adam Cuker, May 2014
 Reversal Strategies for Newer Anticoagulants, May 2013 Today's Hospitalist
Comprehensive article outlining reversal for DOACs with links to useful protocols
 Transitioning to and from the direct oral anticoagulants: a management strategy for clinicians    NEW
J Thromb Thrombolysis Feb 2014, Elsayed Abo-Salem,Richard Becker 8-page article focuses on transitioning to and from DOACs employing a practical pharmacokinetic- and pharmacodynamic-based approach.

VTE

 Management of Venous Thromboembolism: Clinical Guidance from the AC Forum, January 2016    NEW
New practical guidance from AC Forum, developed by 58 leading international experts Free Open Access to all manuscripts published January 2016 in Journal of Thrombosis and Thrombolysis
 The Post Thrombotic Syndrome, Vazquez & Kahn 2010
Hematology 2010 article outlining PTS as a complication of DVT touching on risk factors, prevention & treatment
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