atrial fibrillation and stroke prevention - Continuing Medical ...

Essentials in Primary Care Conference
Wednesday, July 31, 2013
Rivaroxaban: Dosage Conversion
Agent
Heparin
Enoxaparin
Fondaprinux
Conversion Instructions
Discontinue the heparin infusion when the first
evening dose of rivaroxaban is administered
Start rivaroxaban at the time the next evening
dose of enoxaparin was to be administered
Start dabigatran at the time the next dose of
fondaparinux as to be administered
Conversion
From warfarin
To warfarin
Recommendation
Discontinue warfarin and start rivaroxaban
when INR < 3.
No clinical trial data available
May consider: Start warfarin and parenteral
anticoagulant at the time the next dose of
rivaroxaban would have been taken
Rivaroxaban Package Insert
Stroke prevention in Atrial Fibrillation
Apixaban vs warfarin (ARISTOTLE)
Apixaban 5 mg oral twice daily
(2.5 mg twice daily if Age > 80,
< 60 kg body wt, creat > 1.5 mg/dl
+
Warfarin placebo
Randomize
Double blind
(n = 18,201)
Apixaban placebo twice daily
+
Warfarin (target INR 2-3)
Primary outcome: stroke and systemic embolism
Other outcomes: Death, MI, bleeding
Stratified by warfarin-naïve status
• Age 75 years
• Prior stroke, TIA or SE
• CHF or LVEF 40%
• Diabetes mellitus
• Hypertension
Warfarin/warfarin placebo adjusted by INR/sham INR
based on encrypted point-of-care testing device
Granger CB et al. N Engl J Med 2011; 365:981-992.
Jan Basile, MD
Atrial Fibrillation & Stroke Prevention