manejo actual tromboembolismo venoso
TRANSCRIPT
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Venous Thromboembolism (VTE) Management
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Objectives
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Disease Burden of VTE
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Venous Thromboembolism (VTE)
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Clinical Presentations of VTE
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Goals of Treatment for VTE
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Evidence-based Guidelines for Treatment of VTE
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VTE Treatment Studies Direct Oral Anticoagulants
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Pros and Cons of Heparin Lead-In
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VTE Treatment Studies Direct Oral Anticoagulants
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AMPLIFY TrialRandomized, Double-blind, Noninferiority Study
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AMPLIFY Trial Outcomes
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AMPLIFY TrialBleeding Outcomes
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Hokusai-VTE TrialEfficacy Outcomes
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Hokusai-VTE Trial Bleeding Outcomes
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Anticoagulant Treatment of VTE Risk-Benefit of NOAC vs Vitamin K Antagonist
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Extended Treatment of VTE (Secondary Prevention) Risk-Benefit of NOAC and ASA vs Placebo
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Understanding Pharmacokinetics and Drug Exposure to Optimize Outcomes
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AnticoagulationBalancing Risks
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Key Pharmacokinetics of NOACs Absorption, Distribution, Metabolism, Excretion
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Renal Function Impact on NOAC Half Lives
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Meta-analysis of All NOACs vs Warfarin Subgroups
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Dabigatran Concentration vs Clinical Outcomes
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Balancing Benefit/Risk vs Drug ConcentrationTailoring NOAC Dose to the Patient
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Stroke/SEE in Patients With and Without Dose Reduction
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Major Bleeding in Patients With and Without Dose Reduction
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Practical Guidance for Renal Insufficiency
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Drug-Drug Interactions of NOACs
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NOACs and Cancer-associated VTE
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Cancer and Thrombosis -- A Long-recognized Association
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Warfarin Is Often Ineffective for Cancer-associated VTE
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Warfarin Is More Dangerous in Patients With Cancer
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LMWH vs VKA for Cancer-associated VTE
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Tinzaparin vs Warfarin for Cancer-associated VTEPrimary End Points
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The Standard of Care for Cancer-associated VTE Is ≥ 6 Months of LMWH
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Coagulation Cascade
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Patients With Active Cancer From Phase 3 VTE Rx Studies
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Patients With Active Cancer From Phase 3 VTE Rx Studies
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Recurrent VTE Rates on VKAHow do the Subgroups of the NOAC Registration Trials Compare?
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NOACs in Cancer-associated VTEObservational Data Reported at ASH 2015
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Recent Cohort Studies With NOACs
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Prospective, Comparative Studies* of NOACs for Cancer-associated VTE
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Conclusions
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Update on NOAC Antidotes
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NOACsDOACsTSOACsNOACs
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Major Outcomes of NOACs vs Adjusted-Dose Warfarin in SPAF
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Meta-analysis of NOAC VTE Treatment
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To Summarize . . .
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Major Bleeding on NOAC Treatment
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Major Bleeding on Warfarin
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General Approach to NOAC-relatedMajor Bleeding
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Clotting Studies With NOACs
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General Management of Bleeding
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There Are Times...
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NOAC Reversal Agents
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Andexanet alfaAntidote for Factor Xa Inhibitors
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Reversal of Factor Xa Inhibitors With Andexanet alfa
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Idarucizumab Is a True, Specific Antidote to Dabigatran
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RE-VERSE ADA Multicenter, Ongoing, Open-label, Single-arm Phase 3 Study
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Primary End PointClinical Outcomes
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Secondary End PointClinical Outcomes
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RE-VERSE AD
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Conclusions
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Abbreviations
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Abbreviations (cont)
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Abbreviations (cont)
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Abbreviations (cont)