Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran vs. warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361:1139-1151. Abstract
Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365:883-891. Abstract
Granger CB, Alexander HJ, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365:981-992. Abstract
Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369:2093-2104. Abstract
Agnelli G, Buller HR, Cohen A, et al. Apixaban extended treatment of venous thromboemolism. N Engl J Med. 2013;368:699-708 . Abstract
Schulman S, Kearon C, Kakkar AK, et al; RE-MEDY Trial Investigators; RE-SONATE Trial Investigators. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013;368:709-718. Abstract
EINSTEIN Investigators, Bauersachs R, Berkowitz SD, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499-2510. Abstract
Ruff C, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014; 383:955-962. Abstract
Pollack CV Jr, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373:511-520. Abstract
Pollack CV Jr. Coagulation assessment with the new generation of oral anticoagulants. Emerg Med J. 2015 May 18.[Epub ahead of print]
PRADAXA®[package insert]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; January 2015.
Hickey M, Gatien M, Taljaard M, et al. Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department. Circulation. 2013; 128:360-364. Abstract
Sarode R, Milling TJ Jr, Refaai MA, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation. 2013; 128:1234-1243. Abstract
Crowther M, Crowther MA. Antidotes for novel oral anticoagulants: current status and future potential. Arterioscler Thromb Vasc Biol. 2015;35:1736-1745. Abstract

CME

Emergency Management of Bleeding With NOACs: Do We Need a Reversal Agent?

Authors: Manesh R. Patel, MD; W. Frank Peacock, MD; John W. Eikelboom, MBBS, MSc
CME Released: 11/9/2015
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 11/9/2016

Target Audience and Goal Statement

This activity is intended for cardiologists, primary care physicians, and emergency medicine physicians.

Non-vitamin K antagonist oral anticoagulants (NOACs) are gradually replacing current vitamin K antagonists in a variety of clinical settings. Reversal agents of the vitamin K antagonists are available, but little is known about reversal agents for NOACs. The goal of this activity is to provide an update on the current NOACs being used by clinicians and the recently developed NOAC reversal agents and lab assays that can be used to measure their effects in emergency bleeding situations.

Upon completion of this activity, participants will be able to:

Identify strategies for the management of bleeding events for patients taking NOACs
Summarize latest clinical trial data on specific reversal agents

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Moderator(s)

Manesh R. Patel, MD

Associate Professor of Medicine, Duke University Medical Center, Durham, North Carolina

Disclosures

Disclosure: Manesh R. Patel, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer HealthCare Pharmaceuticals; Genzyme Corporation; Janssen Pharmaceuticals, Inc.; Merck & Co., Inc.

Dr Patel does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Patel does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelist(s)

W. Frank Peacock, MD

Professor, Baylor College of Medicine, Houston, Texas

Disclosures

Disclosure: W. Frank Peacock, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Alere; Beckman Coulter, Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Cardiorentis AG; Instrumentation Laboratory; Janssen Pharmaceuticals; Philips Healthcare; Portola Pharmaceuticals, Inc.; Prevencio; Singulex; The Medicines Company; ZS Pharma
Received grants for clinical research from: Abbott Laboratories; Alere; Banyan; Cardiorentis AG; Janssen Pharmaceuticals; Pfizer Inc; Portola Pharmaceuticals, Inc.; Roche; The Medicines Company
Owns stock, stock options, or bonds from: Comprehensive Research Associates LLC; Emergencies in Medicine LLC

Dr Peacock does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Peacock does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

John W. Eikelboom, MBBS, MSc

Associate Professor, McMaster University, Hamilton, Ontario, Canada

Disclosures

Disclosure: John W. Eikelboom, MBBS, MSc, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; GlaxoSmithKline; Janssen Pharmaceuticals; Lilly; Pfizer Inc; Sanofi
Received grants for clinical research from: AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; GlaxoSmithKline; Janssen Pharmaceuticals; Pfizer Inc; Sanofi

Dr Eikelboom does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Eikelboom does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Steering Committee

Keith A. A. Fox, MB, ChB

Professor of Cardiology, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom

Disclosures

Disclosure: Keith A. A. Fox, MB, ChB, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; GlaxoSmithKline; Janssen Pharmaceuticals Products, L.P.; Lilly; Sanofi
Served as a speaker or a member of a speakers bureau for: AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; Janssen Pharmaceuticals Products, L.P.
Received grants for clinical research from: AstraZeneca Pharmaceuticals LP; Bayer HealthCare Pharmaceuticals; GlaxoSmithKline; Janssen Pharmaceuticals Products, L.P.; Lilly

Dan Atar, MD

Professor and Head, Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway

Disclosures

Disclosure: Dan Atar, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Cardiome Pharma Corp.; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; Merck & Co., Inc.; Nycomed; Pfizer Inc.; Sanofi; Takeda Pharmaceuticals North America, Inc.

Lord Ajay K. Kakkar, MD, PhD

Director, Thrombosis Research Institute; Professor of Surgery, University College London, London, United Kingdom

Disclosures

Disclosure: Lord Ajay K. Kakkar, MD, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmcaeuticals, Inc.; Daiichi Sankyo, Inc.; Sanofi
Received grants for clinical research from: Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.

Jessica L. Mega, MD, MPH

Associate Professor of Medicine, Harvard Medical School; Investigator, TIMI Study Group; Cardiologist, Brigham and Women's Hospital, Boston, Massachusetts

Disclosures

Disclosure: Jessica L. Mega, MD, MPH, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: American Genomics; Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Janssen Pharmaceuticals Products, L.P.; Portola Pharmaceuticals, Inc.
Received grants for clinical research from: Accumetrics, Inc.; Bayer HealthCare Pharmaceuticals; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly; Nanosphere, Inc.; Sanofi

P. Gabriel Steg, MD

Professor, Department of Cardiology; Director, Coronary Care Unit, Hôpital Bichat, Service de Cardiologie; Faculté de Médecine Xavier Bichat, Université Paris-Diderot, Paris, France

Disclosures

Disclosure: P. Gabriel Steg, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amarin Corporation plc; AstraZeneca Pharmaceuticals LP; Bayer Healthcare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Daiichi Sankyo, Inc.; GlaxoSmithKline; Janssen Pharmaceuticals, Inc.; Lilly; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Otsuka Pharmaceutical Co., Ltd; Pfizer Inc; Regado Biosciences; Roche; Sanofi; SERVIER; The Medicines Company; VIVUS Inc.
Received grants for clinical research from: Sanofi; SERVIER
Owns stock, stock options, or bonds from: Aterovax

Alexander G. G. Turpie, MD

Professor of Medicine, McMaster University, Hamilton, Ontario, Canada

Disclosures

Disclosure: Alexander G. G. Turpie, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer HealthCare Pharmaceuticals; Boehringer Ingelheim Pharmaceuticals, Inc.; Portola Pharmaceuticals, Inc.
Served as a speaker or a member of a speakers bureau for: Bristol-Myers Squibb Company; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Pfizer Inc

Editor(s)

Caroline M. Padbury, B.Pharm

Lead Scientific Director, Medscape, LLC

Disclosures

Disclosure: Caroline M. Padbury, B.Pharm, has disclosed no relevant financial relationships.

Soumaya El Rouby, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Soumaya El Rouby, has disclosed no relevant financial relationships.

CME Reviewer(s)

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed the following relevant financial relationships:
Received grants for clinical research from: Otsuka Pharmaceutical Co., Ltd.
Served as an advisor or consultant for: HeartWare International, Inc; Thoratec Corporation.

Accreditation Statements

For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

From Medscape Education Cardiology

CME

Emergency Management of Bleeding With NOACs: Do We Need a Reversal Agent?

Authors: Manesh R. Patel, MD; W. Frank Peacock, MD; John W. Eikelboom, MBBS, MScFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 11/9/2015

Valid for credit through: 11/9/2016

processing....

PDF transferível em português

« Return to: Emergency Management of Bleeding With NOACs: Do We Need a Reversal Agent?

Download Slides

PDF Downloads

Print
Like Tweet

References

Faculty and Disclosures

Moderator(s)

Manesh R. Patel, MD

Panelist(s)

W. Frank Peacock, MD

John W. Eikelboom, MBBS, MSc

Steering Committee

Keith A. A. Fox, MB, ChB

Dan Atar, MD

Lord Ajay K. Kakkar, MD, PhD

Jessica L. Mega, MD, MPH

P. Gabriel Steg, MD

Alexander G. G. Turpie, MD

Editor(s)

Caroline M. Padbury, B.Pharm

Soumaya El Rouby, PhD

CME Reviewer(s)

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

CME

Emergency Management of Bleeding With NOACs: Do We Need a Reversal Agent?

Target Audience and Goal Statement

Disclosures

Moderator(s)

Manesh R. Patel, MD

Panelist(s)

W. Frank Peacock, MD

John W. Eikelboom, MBBS, MSc

Steering Committee

Keith A. A. Fox, MB, ChB

Dan Atar, MD

Lord Ajay K. Kakkar, MD, PhD

Jessica L. Mega, MD, MPH

P. Gabriel Steg, MD

Alexander G. G. Turpie, MD

Editor(s)

Caroline M. Padbury, B.Pharm

Soumaya El Rouby, PhD

CME Reviewer(s)

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Emergency Management of Bleeding With NOACs: Do We Need a Reversal Agent?

PDF transferível em português

PDF Downloads