Topics in Cardiology

Olivia Ramey, PharmD

Mallory Carter, PharmD

August 16, 2023

Agenda
• Anticoagulation
• Lipids
• ASCVD
• Emerging Evidence
Objectives
1. Compare and contrast appropriate use of different
anticoagulants based on CHEST guidelines.
2. Generate an anticoagulation therapy plan, including
perioperative management for a patient with Atrial
Fibrillation.
3. Evaluate American and European guidelines for
cholesterol management.
4. Assess new evidence for prevention and treatment of
cardiovascular conditions.
Anticoagulation
DOACs
Heparins
Warfarin
Coagulation
Cascade1
Direct Oral Anticoagulants (DOACs)2
Agents: apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edoxaban (Savaysa), and
betrixaban (Bevyxxa)

Mechanism:
- Factor Xa Inhibitor: directly inhibits factor Xa to prevent clot formation/growth
- Direct Thrombin Inhibitor (dabigatran): directly inhibits thrombin to decrease the amount of
fibrin and prevent clot formation/growth

Place in Therapy: preferred for most anticoagulation EXCEPT mechanical heart valve, mitral stenosis, or
antiphospholipid syndrome
- Indication-specific
- Require monitoring of renal and hepatic function
- Adherence concerns

Outcomes: similar efficacy in preventing stroke as warfarin, decreased risk of major bleeding, increased
risk of GI bleeding
 General Overview Of DOACs2
DOAC Half-Life Renal Dosing Hepatic Dosing Other Landmark Trial

Apixaban 8-15 hours Yes (27%) Child-Pugh C Consider ARISTOTLE

indication, age,
weight

Rivaroxaban 5-9 hours Yes (35%) Child-Pugh B and C Take with food ROCKET AF
at higher doses

Dabigatran 12-17 hours Yes (80%) None RE-LY

Edoxaban 10-14 hours Yes (50%) Child-Pugh B and C Avoid in CrCl > ENGAGE AF –
95 TIMI 48
Chen A, Stecker E, Warden BA. Direct oral anticoagulant use: a practical guide to common clinical challenges. JAHA. 2020;9(13). doi: 10.1161/JAHA.120.017559.
 DOAC-Specific Indications3
Indications
NVAF stroke/ Stable CAD DVT/PE Stable PAD DVT/PE VTE VTE ACS HIT Left Acute, VTE
embolism Prevention Treatment prophylaxis in prophylaxis ventricular symptomatic prophylaxis
prevention acutely in THA or thrombus SVT following
medically ill TKA (treatment/ nonmajor
DOAC patients prevention) orthopedic
surgery of
lower limb
X X X X X X X O O O O O

Rivaroxaban R (≤50) R (<15) R (<30) R (<15) R (<30) R (<30) R (<30) R (<30) R (<30) R (<50) R (<30) R (<30)

X X X X O O
Apixaban
R (SCr≥1.5, R (<25 or R (<25 or Scr R (<30) R
TBW≤60kg, SCr>2.5) >2.5) (SCr≥1.5, TB
age≥80) W≤60kg, ag
e≥80)
X X X X (THA)
Dabigatran O (TKA)
R (≤30) R (≤30) R (≤30)
R (≤30)
X X
Edoxaban
R (>95, ≤50) R (≤50 and
TBW≤60kg)
 DOAC Obesity Dosing2,4-6
Previous recommendation from International Society on Thrombosis and Hemostasis: Avoid use
in patients >120kg and/or BMI > 40kg/m2
Chen A, Stecker E, Warden BA. Direct oral anticoagulant use: a practical guide to common clinical challenges. JAHA. 2020;9(13). doi: 10.1161/JAHA.120.017559.
Access and Affordability - Apixaban

Patient Free 30-day

Copay Card Rebate Free Samples
Assistance Trial
• No Rx • $10/month • Once per • Mail in rebate • Provider
coverage for up to 2 lifetime if pharmacy offices can
(Part D) years ($6400 • No does not request free
• Proof of max savings) restrictions honor copay samples
income • No card
• Out of pocket government
Rx expenses insurance
• Sent to
provider
office
Access and Affordability - Apixaban
Access and Affordability - Rivaroxaban
Patient CarePath Savings
Select Program
Assistance Program
• Hospital • $10/month (no • $85/month
application limit for first 3 • For commercial
months, then or government
limit of insured patients
$200/month, • Register April 1
max savings of and expires
$3400/year) December 31
• Commercially
insured patients
Access and Affordability - Dabigatran

Medicare Part D
Savings Card
Extra Help Subsidy
• $0/month (valid • Reduced
for 12 uses or premiums
$2400/year max • Lower Rx costs
savings)
• Commercially
insured patients
 Unfractionated Heparin (UFH)7,8
Mechanism of Action: binds to antithrombin which induces a conformational change that increases the
rate at which antithrombin inactivates factor Xa and factor IIa, thereby preventing the conversion of
fibrinogen to fibrin and preventing clot formation

Place in Therapy: rapid anticoagulation, acute conditions, bridging/perioperative (t ½ = 30-90 minutes)

- Requires monitoring of aPTT or anti-Xa levels
- aPTT: 1.5-2.5x control
- Anti-Xa: 0.3-0.7 U/mL
- TBW used for dosing
- Monitor platelets/CBC at baseline and every 2-3 days
 Low Molecular Weight Heparin (LMWH)9
Agents: enoxaparin (Lovenox) and dalteparin (Fragmin)

Mechanism of Action: binds to antithrombin which induces a conformational change that increases
the rate at which antithrombin inactivates factor Xa and factor IIa, thereby preventing the conversion
of fibrinogen to fibrin and preventing clot formation. LMWH has greater Xa activity than IIa activity.

Place in Therapy: bridging (t ½ = 3-7hrs), anticoagulation in pregnancy, ACS, inpatient prophylaxis

- More specific for factor Xa than UFH = more predictable
- Anti-Xa levels as indicated for higher-risk patients (underweight, obese, pregnant, etc.)
- TBW used for dosing
- Monitor platelets/CBC
 Warfarin10,11
Mechanism of Action: Inhibits vitamin K epoxide reductase (VKOR)
which reduces the production of active factors II, VII, IX, and X. Also
reduces production of protein C and S.

Place in Therapy: mechanical prosthetic heart valves, moderate-

severe mitral stenosis, thrombophilias/antiphospholipid syndrome
- Requires extensive monitoring of INR
- Goal depends on indication (2.0-3.0 or 2.5-3.5)
- Time in Therapeutic Range ≥ 65%
- Dosed via a weekly dose

Interacts with a variety of medications, foods, lifestyle factors, disease

states.
Patient Education
Bruising
Bleeding
Epistaxis (unexplained,
Gums
unresolving)

Coffee-ground
Hematoma Hematuria
emesis

When to seek
Blood in stool Fall Risk
help
Transitioning Anticoagulants2
DOAC to Stop first DOAC
Start new DOAC
at next
DOAC scheduled dose

Warfarin to Stop warfarin

Start DOAC
when INR < 2
DOAC (or 2.5)

DOAC to Start warfarin

Stop DOAC 3
OR stop DOAC,
bridge warfarin
warfarin days after
with LMWH

DOAC to Start parenteral

agent at next
parenteral Stop DOAC
scheduled
agent DOAC dose

OR Start DOAC
Parenteral Start DOAC
within 2 hours
at next
to DOAC of stopping UFH
scheduled dose
of LMWH
 Anticoagulation Clinic: DOAC Service
Evaluate
Provider contact Risk
EPIC Report/ Referral appropriateness Patient interview Follow up
(if needed) stratification
of therapy

Patient Interview

• Adherence
• Access
• Adverse Effects
• Drug Interactions
• Monitoring
Atrial Fibrillation (AF)12,13
AF Goals12
Anticoagulation Initiation in AF12,13

Treat if:
• ≥ 1 for males
• ≥ 2 for females
Bleeding Risk Considerations in AF12

Increased monitoring if ≥ 3
AF Anticoagulant Recommendations12
DOAC vs. Warfarin12
Outcome RR CI P-value
Stroke or Systemic 0.81 0.73-0.95 <0.0001
Embolism

Hemorrhagic Stroke 0.49 0.38-0.64 <0.0001

Ischemic Stroke 0.92 0.83-1.02 0.10

All-Cause Mortality 0.90 0.85-0.95 0.0003

Major Bleeding 0.86 0.73-1.00 0.06

Intracranial 0.48 0.39-0.59 <0.0001
Hemorrhage
GI Bleeding 1.25 1.01-1.55 0.04
Anticoagulation Algorithm in AF12
Cardioversion12

• Therapeutic anticoagulation x 3 weeks

AF > 48 hrs
prior to cardioversion
• Therapeutic anticoagulation x 4 weeks
after cardioversion

• Start full anticoagulation at presentation

AF ≤ 48 hrs
(goal = therapeutic)
• Anticoagulation x 4 weeks after
cardioversion
PCI/Stenting
in AF2,12
PCI/Stenting in AF14
Duration of Anticoagulation Therapy in AF12
Special Populations – Pregnancy and CKD12
Venous Thromboembolism15
VTE Treatment15
15mg BID with Then 20mg daily
Rivaroxaban food x 21 days with food

10mg BID x 7
Apixaban days
Then 5mg BID

Requires 5 days
Dabigatran 150mg BID of parenteral
treatment

60mg daily (or Requires 5-10

30mg for days of
Edoxaban renal/weight parenteral
adjustment) treatment
Anticoagulation Duration15

Evaluate for
Provoked 3 months
continuation Rivaroxaban Apixaban

Unprovoked (or 10mg 2.5mg

provoked by Indefinite Reevaluate
persistant risk
3 months
continuation annually daily BID
factor)
VTE Prophylaxis15
Major
Immobility/
Surgery Trauma/Acute
Travel
Illness

Medications:
Cancer Pregnancy Estrogens,
ESAs

Age Obesity Thrombophilia

 Patient Case
PC is a 54-year-old female who underwent a hysterectomy 2 weeks ago. She calls the office complaining of
redness, swelling, and pain in her lower right calf. After speaking to you, she comes to the hospital for imaging,
where she is diagnosed with a DVT.

PMH: HTN, abnormal uterine bleeding, T2DM, CKD Stage 3

Vitals: BP 134/78, Pulse 82, Wt: 90kg, Ht: 64'', BMI: 34 kg/m2
Labs:
• Scr: 1.6
• A1c: 7.2% 1. What should we consider before selecting an
• LFTs: WNL anticoagulant?
2. Which anticoagulant and dose would you choose for
Meds: treatment?
• Amlodipine 5mg daily 3. How long should she be anticoagulated?
• Losartan 50mg daily
4. Patient's pharmacy calls and says the medication requires a
• Metformin 500mg BID
PA, what can you do?
• Ozempic 0.5mg weekly
• Estradiol 1mg daily
Periprocedural Management16
Patient -
Specific
Thrombotic
Risk16
Procedural
Bleed
Risk16
Example16
Patient-
Specific
Bleed
Risk17
Warfarin Interruption16,17
DOAC Interruption16,17
Deciding
to
Bridge17
Management of Heparin Bridging16

Stop therapeutic
UFH (t ½: dosing ≥ 4hrs Resume ≥ 24hrs

30-90min) before
procedure
after procedure

Administer last
LMWH (t dose 24hrs OR administer a Resume ≥ 24hrs

½: 3-7hrs) before
procedure
half dose after procedure
 Patient Case
JS (76yof) calls the office because she has an upcoming procedure and is wondering if she should hold her warfarin.
JS has Afib and is receiving a pacemaker in 1 month. How should you manage her periprocedural anticoagulation?

PMH: Afib, HLD, HTN, T2DM, osteoarthritis

Vitals: BP 124/84, Pulse 96, Wt: 58kg, Ht: 66"
Labs:
• SCr: 1.0
• LFTs: WNL
• A1c: 6.6%
• INR: 2.7

Meds:
• Metoprolol succinate 50mg daily
• Warfarin 5mg MWFSat, 2.5mg TRSun (weekly: 27.5mg)
• Lisinopril 10mg daily
• Metformin 1,000mg BID
• Atorvastatin 20mg daily
• Voltaren gel 1%
Cholesterol Management
Heart disease facts. Centers for Disease Control and Prevention. May 15, 2023. Accessed August 14, 2023. https://www.cdc.gov/heartdisease/facts.htm
 Obesity
Prevalence in
the US, 2021

Adult obesity prevalence maps. Centers for Disease Control and Prevention. March 17, 2023. Accessed August 15, 2023. https://www.cdc.gov/obesity/data/prevalence-maps.html#age.
 Heart Healthy Lifestyle18
90-150 minutes
of moderate- Healthy eating
intensity aerobic habits
exercise weekly

Weight loss if
Smoking
overweight or
cessation
obese

This Photo by Unknown author is licensed under CC BY-

NC.
Leading an Active Lifestyle18
 Lifestyle Changes
and
Impact on Lipids19
 Statin Benefit Groups20
Diabetes, age
Age 40-75, LDL
Clinical ASCVD LDL ≥ 190mg/dL 40-75, LDL 70-
70-189 mg/dL
189mg/dL

10-year ASCVD
High intensity High intensity Moderate risk 7.5-<20%
statin statin intensity statin • Moderate Intensity
statin*

10-year ASCVD
risk ≥20%
• High intensity statin
 Primary
Prevention
Algorithm20
Coronary Artery
Calcium
Measurement20
ASCVD Risk Enhancers20
Secondary
Prevention
Algorithm20
 Defining
Very
High Risk20
 LDL Targets19,20

2018 ACC/AHA Guideline 2019 ESC/EAS Dyslipidemia

on the Management of
Blood Cholesterol:
• Consider addition of non-statin to
achieve LDL ≤70mg/dL
for patients with very high risk
ASCVD
Guidelines
• LDL goal of ≤55mg/dL for patients
with very high risk ASCVD
• Consider LDL goal of ≤40mg/dL
for patients with multiple
CV events in the past 2 years
while on statin
 LDL Targets21,22
2022 ACC/AHA Expert Consensus Decision Pathway
• Recommends targeting LDL <55mg/dL for secondary prevention in very
high risk ASCVD
Meta-analysis of 8 statin RCTs enrolling 38,153 patients:
• >40% of participants in high-intensity statin arm did not achieve LDL
<70mg/dL
• Compared to LDL 75 – 100mg/dL for MACE:
• <50mg/dL (adjusted HR 0.81; 95% CI 0.70-0.95)
Statin Intensity and LDL Reduction20
 Hydrophilic vs. Hydrophobic Statins

Blue = hydrophilic
Red = lipophilic Ana-Maria, Pelin & Gavat, Cristian & Balan, Gabriela & Popescu, Eugenia & Costinela, Valerica & Georgescu, Costinela. (2017). Particularities of Statin Therapy in
Diabetic Patients. Revista de Chimie -Bucharest- Original Edition-. 68. 720-725. 10.37358/RC.17.4.5538.
Incidence
of
Statin
Adverse
Effects20
Non-Statin Cholesterol Lowering
Medications
 Ezetimibe3,23
• Inhibits sterol transporter, Niemann-Pick C1-Like-1 (NPC1L1)
in intestinal brush border
• Decreases delivery of cholesterol to the liver and increases
Mechanism: clearance of cholesterol from the blood

• Very high risk ASCVD: when LDL ≥70mg/dL

Place in • Primary prevention when LDL ≥190mg/dL and remains
therapy:

• 15-20% reduction in LDL

• Reduces MACE
Outcomes: • No effect on CV mortality

Bove, Marilisa & Fogacci, Federica & Cicero, Arrigo. (2017). Pharmacokinetic drug evaluation of ezetimibe + simvastatin for the treatment of
hypercholesterolemia. Expert Opinion on Drug Metabolism & Toxicology. 13. 10.1080/17425255.2017.1381085.
Bardolia C, Amin NS, Turgeon J. Emerging Non-statin Treatment Options for Lowering Low-Density Lipoprotein Cholesterol. Front Cardiovasc Med. 2021;8:789931. Published 2021 Nov 17.
doi:10.3389/fcvm.2021.789931
 PCSK9 Inhibitor mAb3,24
Agents: Mechanism: Place in therapy: Outcomes:

• Alirocumab, • Human monoclonal • After ezetimibe • 50-60% reduction in

(Praluent®) antibodies that • Very high risk LDL
and Evolucumab, prevent binding of ASCVD when • Reduction in MACE
(Repatha®) proprotein convertase • No effect on CV
LDL ≥70mg/dL
subtilisin kexin type 9 mortality
(PCSK9) to LDL • Homozygous familial
receptors on hypercholesterolemia
hepatocytes • Primary
• Increased availability of prevention when LDL
LDLR to clear LDL from ≥190mg/dL
the bloodstream for
break down in the
liver
Bardolia C, Amin NS, Turgeon J. Emerging Non-statin Treatment Options for Lowering Low-Density Lipoprotein Cholesterol. Front Cardiovasc Med. 2021;8:789931. Published 2021 Nov 17.
doi:10.3389/fcvm.2021.789931
 FOURIER Trial (Evolocumab)25
Significant reduction of
nonfatal MI, ischemic stroke,
Number needed to treat
and coronary revascularization
•Least-squares mean in evolucumab group •Continued reduction of hazard
reduction to LDL of 30mg/dL ratio the lower the LDL
at 48 weeks level achieved
•1344 patients [9.8%] vs. 1563 •67 patients need to be treated
•Median 2.2 years of follow-up patients [11.3%]; hazard ratio, to prevent one event
0.85; 95% confidence interval
[CI], 0.79 to 0.92; P<0.001
•No significant difference in all-
cause mortality or CV
mortality
Median baseline LDL was
92mg/dL among 27,564 Exploratory analysis of this
patients with ASCVD receiving data
statin therapy
 Patient Access: Evolocumab
Amgen Safety Net Foundation Copay Card
• Medicare Part D or uninsured • Commercial insurance
• 500% FPL • $5 per copay
ODYSSEY Outcomes Trial (Alirocumab)26
Median baseline LDL was
93md/dL among 18,924
people with recent
ACS receiving statin
therapy
• Treat to target LDL goal of 25 –
50mg/dL
• Median follow-up 2.8 years
Significant reduction in
nonfatal MI/stroke, unstable
angina
requiring hospitalization, and
ischemia-mediated 63 patients would need to
revascularization procedure be treated to prevent one
• 903 patients (9.5%) in the event
alirocumab group and in 1052
patients (11.1%) in the placebo
group (HR, 0.85; 95% CI, 0.78 to
0.93; P<0.001
• No significant difference in death due
to CHD, MI, or ischemic stroke
 Patient Access: Alirocumab
MyPraluent Patient Assistance Copay Card
Program
• Medicare Part D or • Commercial insurance
uninsured/underinsured • $35 per copay
• 300% FPL
 Place in Small
Mechanism: Outcomes:
therapy:
Interfering
Similar to PCSK9
inhibitors, but inhibits
both intracellular and
Ribonucleic
extracellular PCSK9 50% reduction in LDL
Acid
Directs breakdown of
PCSK9 mRNA
Approved in 2020; not
in 2018 ACC/AHA
(siRNA)3
guideline

Increases LDL-C Cardiovascular

receptor expression on outcomes trial ongoing
hepatocytes, leading to
increased LDL-C
uptake
 Patient Access: Inclisiran
Novartis Patient Assistance Copay Card
Foundation
• Must be uninsured or underinsured • Commercial insurance only
• 400% FPL • 12 months of $0 copay
• No government insurance
Bardolia C, Amin NS, Turgeon J. Emerging Non-statin Treatment Options for Lowering Low-Density Lipoprotein Cholesterol. Front Cardiovasc Med. 2021;8:789931. Published 2021 Nov 17.
doi:10.3389/fcvm.2021.789931
 Mechanism:
• Bempedoic acid (Nexletol®) is an adenosine
triphosphate-citrate lyase (ACL) inhibitor.
• ACL is an enzyme upstream of Hmg-CoA
reductase in the cholesterol biosynthesis pathway.
• Reduces cholesterol synthesis and LDL-C in the
blood via upregulation of LDL receptors

Bempedoic Place in therapy:

Acid3,27 • Approved in 2020; not in 2018 ACC/AHA guideline

Outcomes:
• Decreases LDL by 17 – 38%
• Reduces MACE in patients unable to tolerate
statins
• No impact on CV death or all-cause mortality,
nonfatal stroke
 Patient Access: Bempedoic Acid
HealthWell Foundation Copay Card
• May have commercial insurance or • Commercial insurance only
Medicare Part D insurance • 12 months of copays covered at
• Income requirements not disclosed $10 per 30 day supply
• This is a generalized program, not
specific to bempedoic acid
Bardolia C, Amin NS, Turgeon J. Emerging Non-statin Treatment Options for Lowering Low-Density Lipoprotein Cholesterol. Front Cardiovasc Med. 2021;8:789931. Published 2021 Nov 17.
doi:10.3389/fcvm.2021.789931
 Fibric Acid Derivatives3,20
Agents:
• Tricor®(fenofibrate) and Lopid®(gemfibrozil)

Mechanism:
• Peroxisome proliferator-activated receptor-alpha (PPARα) activation, which downregulates apoprotein C-
III by activating lipoprotein lipase
• This results in an increase in lipolysis and elimination of triglyceride-rich particles

Place in Therapy:
• Hypertriglyceridemia ≥500mg/dL

Outcomes:
• Reduces plasma triglycerides by 30 – 60%
• Increases HDL by 10 – 20%
 Bile Acid Sequestrants3,20
Agents:
• Cholestyramine (Questran®), colesevelam (Welchol®), colestipol (Colestid®)

Mechanism:
• Formation of a nonabsorbable complex with bile acids in the intestine, and subsequent release of Cl-
• Inhibits enterohepatic reuptake of intestinal bile salts and thereby increases the fecal loss of bile salt-
bound LDL
• No systemic absorption

Place in Therapy:
• Limited due to ADRs and potential for hypertriglyceridemia

Outcomes:
• Reduces LDL by 15 – 30%
Subjective:
Patient Case
AW is a 58 YO white male presenting to discuss results of his recent lipid panel
CC "I do not want to take cholesterol meds!"
He is concerned about side effects like muscle cramps, and he's heard that statins cause diabetes.
He is considering focusing on lifestyle interventions alone.

Objective:
• PMH: hypertension and hyperlipidemia, former smoker 1. How would you discuss ASCVD risk with this
• BP in office today: 118/62 specific patient?
• LDL = 155mg/dL; TC = 220, HDL = 21 2. If AW decides to start statin treatment, which
• ASCVD risk score is 13% statin and dose would you pick and why?
• A1c = 5.1%
• BMI = 27

Medications:
• Lisinopril 20mg daily
• Aspirin 81mg daily
Peripheral Arterial Disease28,29

• Aspirin or clopidogrel
• Statin
Symptomatic • Reduce incidence of MACE and CV death

PAD: • Supervised exercise

• Cilostazol
• Improves symptoms and increases walking distance
 VOYAGER-PAD Trial30
Rivaroxaban recently received FDA approval for PAD
• Dose: 2.5mg BID + aspirin

Study Methods:
- 6564 participants with PAD and lower limb revascularization
- Rivaroxaban + aspirin vs. Placebo

Results:
• Achieved significance on composite primary endpoint
(P=0.009)
• Only significant portion of primary endpoint was acute limb
ischemia
• 155 (4.7%) vs. 227 (6.9%) in rivaroxaban vs. Placebo groups
[HR 0.67 (0.55–0.82)]
Emerging Evidence
Aspirin for Primary Prevention31
 Colchicine32
• RCT of 5522 patients with CHD randomized to colchicine or placebo
• Median follow-up 28.6 months
• Mean age 65, >80% male
• About 90% on single or DAPT; 94% on statin

Outcomes:
- Primary composite of CV death, MI, ischemic stroke, coronary
revascularization HR 0.69 (0.57 - 0.83), p<0.0001
- Nonfatal MI, no significant findings for the independent outcome of CV
death
 MRAs in AF33

Methods: Systematic review and meta-analysis of 24 randomized

controlled trials/observational studies.
• 7,914 patients enrolled, 2,843 received an MRA
(spironolactone, eplerenone, canrenone)
• Median age: 64.2
• Median LVEF: 49.7%
Outcomes: Significant reduction in AF occurrence with MRAs (15.0%
vs. 32.2%; OR 0.55; 95% CI, 0.44-0.70; p<0.0001), especially with
regards to recurrent AF episodes (OR 0.42; 95% CI, 0.31-0.59; p<0.0001)
AF Prediction34

Methods: Evaluated prospective UK Biobank and Framingham Heart

Study cohorts for AF incidence.
•314,280 UKB participants, of which, 5.7% developed AF over
median time of 7.6 years
•Validated in FHS cohort

Results:
•Hypertension, age, BMI, male sex, sleep apnea, smoking, and
alcohol were predictive variables (P < 0.001)
•Physical inactivity (HR 1.01, 95% CI 0.96-1.05, P = 0.80) and diabetes
(HR 1.03, 95% CI 0.97-1.09, P = 0.38) were not significant
Segan L, Canovas R, Nanayakkara S, et al. New-onset atrial fibrillation prediction: the HARMS2-AF risk score. European Heart Journal. 2023. doi:10.1093/eurheartj/ehad375.
Questions?
References
1. Paulus E, Komperda K, Park G, Fusco J. Anticoagulation therapy considerations in Factor VII deficiency. Drug Saf Case Rep. 2016;3(1):8. doi: 10.1007/s40800-016-0031-y.
2. Chen A, Stecker E, Warden BA. Direct oral anticoagulant use: a practical guide to common clinical challenges. JAHA. 2020;9(13). doi: 10.1161/JAHA.120.017559.
3. Lexicomp Online, Lexi-Drugs Online. Waltham, MA: UpToDate, Inc.; Accessed August 14 2023. https://online.lexi.com
4. Martin KA, Byer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S. Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: updated
communication from the ISTH SCC Subcommittee on Control of Anticoagulation. JTH. 2021;19(8):1874-1882. doi: 10.1111/jth.15358
5. Jamieson MJ, Byon W, Dettloff RW, et al. Apixaban use in obese patients: a review of the pharmacokinetic, interventional, and observational study data. Am J Cardiovasc Drugs. 2022;22(6):615-631. doi:
10.1007/s40256-022-00524-x.
6. Wiethron EE, Bell CM, Wiggins BS. Effectiveness and safety of direct oral anticoagulants in patients with nonvalvular atrial fibrillation and weight >120 kilograms versus 60-120 kilograms. Am J Cardiovasc
Drugs. 2021;21:545-551.
7. Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/
8. Hirsh J, Anand SS, Halperin JL, Fuster V. Guide to anticoagulant therapy: heparin, a statement for healthcare professionals from the American Heart Association. Cir. 2001;103(24):2994-3018. doi:
10.1161/01.CIR.103.24.2994.
9. Jupalli A, Iqbal AM. Enoxaparin. [Updated 2022 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539865/
10. Angiolillo DJ, Bhatt DL, Cannon CP, et al. Antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention. Circ. 2021;143(6):583-59. Doi:
10.1161/CIRCULATIONHA.120.050438.
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