Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation

Kevin Lao, Mercer University College of Pharmacy

The 2016 European Society of Cardiology guidelines recommend a short period of triple therapy (oral anticoagulant [OAC], aspirin, clopidogrel) for patients with atrial fibrillation (AFib) undergoing percutaneous coronary intervention (PCI) with a stent placement. [1]

Contrary to the European guidelines, the American Heart Association guidelines state that it may be reasonable to use clopidogrel with OAC without aspirin in AFib patients with CHA2DS2-VASc score ≥ 2 following PCI based on evidence that showed higher rates of bleeding with triple therapy. [2] Additionally, one previous trial has shown that dual therapy (warfarin + clopidogrel [P2Y12 inhibitor]) was associated with lower incidence of bleeding without increased rates of stent thrombosis in PCI patients compared to triple therapy. [3]

With the availability of the new oral anticoagulant (NOAC), some evidence suggests that NOAC, instead of warfarin, with a P2Y12 inhibitor (i.e. clopidogrel) may be an effective thromboprophylaxis in PCI patients. Therefore, the RE-DUAL PCI trial aimed to compare the efficacy and safety of dual therapy composed of dabigatran and P2Y12 inhibitor among patients with AFib undergoing PCI. [4]

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Bivalirudin vs. Heparin for Improving Clinical Outcomes in PCI patients

Akpan Anani, Mercer College of Pharmacy

For patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS), anticoagulant therapy is necessitated by risk of thrombotic events. [1] Angiomax® (bivalirudin) is a direct thrombin inhibitor indicated for patients undergoing PCI and concurrently using a glycoprotein IIb/IIIa inhibitor (GPI). [2] Bivalirudin has been shown in some studies to cause less major bleeding than Hep-Lock® (heparin) in myocardial infarction (MI) patients needing anticoagulation [1,3]; however, limited research exists comparing bivalirudin to heparin for assessment of repeat MI or all-cause mortality risk.

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Enoxaparin for Prevention of Unexplained Recurrent Miscarriage: A Multicenter Randomized Double-Blind Placebo-Controlled Trial

Kingsley Onokalah, PharmD candidate 2015, Mercer University College of Pharmacy

Recurrent miscarriage is defined as three pregnancy losses before twenty weeks gestation.1  It occurs in 10% to 15% of pregnancies and recurs in 5% of subsequent pregnancies.  Pasquier et al state that many experts extend the definition of recurrent miscarriage to two pregnancy losses since the recurrence rate is similar to that of three losses.2

Recurrent miscarriage may be attributed to numerous factors, including antiphospholipid syndrome, thrombophilias, hormonal or metabolic disorders, infection, genetics, and age.1  Per the Practice Committee of the American Society for Reproductive Medicine, most miscarriages occur intermittently and are thought to result from genetic causes that are mostly influenced by maternal age.3

According to a review of nine studies conducted by de Jong et al examining the use of anticoagulants in women with recurrent miscarriages with or without inherited thrombophilia, evidence does not support the use of anticoagulants with idiopathic recurrent pregnancies.4

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Factor XI Antisense Oligonucleotide for Prevention of Venous Thrombosis

LanAnh Ngo, PharmD Candidate 2015 Mercer University College of Pharmacy

Current antithrombotic therapies have significant impacts on patient outcomes. These therapies are important in many different types of settings, but is often associated with a risk of bleeding. An emerging new target of therapy, factor XI antisense oligonucleotide, functions to reduce the levels of factor XI, thereby reducing levels of thrombosis, but without the risk of bleeding.1

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