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Resource Center

Disease State Management

Atrial Fibrillation - Stroke Prevention

 2016 European Society of Cardiology Guidelines for the management of atrial fibrillation, 8/16    NEW
Comprehensive 90 page guideline covering all aspects of disease state; epidemiology, risk assessment, diagnosis, screening, treatment; includes some useful decision trees & thorough discussion of drug therapy
 2016 Provider Toolkit by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2)
Created by a consortium of anticoagulation clinics and experts from across the state of Michigan; contains Afib and VTE risk assessment, patient selection, intiation for Warfarin and DOACs
 AHA Algorithmic Approach to Stroke Prevention in Atrial Fibrillation
 AHA/ACC/HRS 2014 Guideline for the Management of Atrial Fibrillation
January 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society
 Assessing Stroke & Bleeding Risk in Atrial Fibrillation - Consensus Statement 2012
 Cardiovascular, Bleeding, & Mortality Risks in Elderly Medicare Patients Treated w/ Dabigatran or Warfarin for Non-Valvular Atrial Fibrillation    NEW
Circulation, published online October 30, 2014; Graham, Reichman, Wernecke, Zhang, Southworth, Levenson, Sheu, MPH2; Mott, Goulding, Houstoun, MaCurdy, Worrall
 CHA2DS2-VASc Online Calculator for Atrial Fibrillation Stroke Risk
 CHA2DS2-VASc validation article (Lip 2010)
 CHADS2 Online Calculator
 CHADS2 Score - Validation Article (Gage 2001)
 Characterizing Major Bleeding in Patients w/ Nonvalvular Atrial Fibrillation: A Pharmacovigilance Study of 27,467 Patients Taking Rivaroxaban    NEW
Overview of study evaluating major bleeding (MB) in NVAF patients treated with rivaroxaban in a real-world clinical setting; Published in Clinical Cardiology 2015, Sally Tamayo, MD; W. Frank Peacock, MD; Manesh Patel, MD; Nicholas Sicignano, MPH; Kathleen P. Hopf, MPH; Larry E. Fields, MD, MBA; Troy Sarich, PhD; Shujian Wu, MD, PhD; Daniel Yannicelli, MD; Zhong Yuan, MD, PhD
 Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation    NEW
Journal of Internal Medicine, 2015; A. M. Shields & G. Y. H. Lip; Review of how to choose the right DOAC for patients with non-valvular AF; includes risk assessment, pharmacology considerations, a decision tree and case-based examples
 Clinical Practice Guideline on Use of Antithrombotics in NVAF July 2014    NEW
17 page guide outlining considerations in deciding between ASA, warfarin and various DOAC agents from UW Health, July 2014. Includes flow diagram that points providers in the direction of appropriate agents based on patient-specific information.
 Efficacy & Safety of New Oral Anticoagulants with Warfarin in Patients with NVAF, Meta-Analysis 3/14    NEW
March 2014 article from The Lancet evaluating new oral anticoagulants with warfarin in patients with NVAF through analysis of randomised trials RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE AF–TIMI by Christian T Ruff , Robert P Giugliano, Eugene Braunwald, Elaine B Hoff man, Naveen Deenadayalu, Michael D Ezekowitz, A John Camm,Jeff rey I Weitz, Basil S Lewis, Alexander Parkhomenko, Takeshi Yamashita, Elliott M Antman
 European Heart Rhythm Association Practical Guide on use of DOACs in Non-Valvular AFIB
 HAS-BLED Online Bleeding Risk Calculator
 Oral Agents for Stroke Prevention in Nonvalvular AF (LINK)
 Oral Agents for Stroke Prevention in Nonvalvular AF (PDF)
 Predicting the risk of recurrent venous thromboembolism (VTE), 2/2015    NEW
Reviews the impact of clinical and laboratory risk factors for recurrent VTE; J of Thrombosis and Throbolysis; Michael B. Streiff
 Preventing AFib Related Strokes Powerpoint
 Rates, mgmt & outcome of rivaroxaban bleeding in daily care: results fr Dresden NOAC registry    NEW
Article from May 2014 "Blood" outlining the Dresden Registry, comparing rivaroxaban bleeding rates to those reported for vitamin K antagonists; Beyer-Westendorf, F¨ orster, Pannach, Ebertz, Gelbricht, Thieme, Franziska Michalski,1 Christina K¨ ohler,1 Sebastian Werth, Sahin, Tittl, H¨ansel, Weiss
 Stroke Risk Scorecard, National Stroke Association
Downloadable tool for providers to review with patients

Patient Assistance Resources

 Apixaban (Eliquis) link for free 30 day supply and co-pay savings card    NEW
 Apixaban (Eliquis) patient assistance for uninsured or low-income    NEW
 Cover My Meds website
helpful E-tool for case managers and others to streamline prior authorization
 Dabigatran (Pradaxa) Patient Cares Foundation
Boehringer Ingelheim Cares Foundation Patient Assistance Program Web Portal
 Dabigatran (Pradaxa) Patient Savings Card    NEW
Co-pay savings card for commercial insurance holders
 Dalteparin (Fragmin) Injectable LMWH Patient Assistance    NEW
 Edoxaban Patient savings card    NEW
link to online source to register for savings card
 Enoxaparin (Lovenox) injectable LMWH    NEW
Sanofi Patient Connection; benefit verification,authorization, patient assistance, billing and coding support and claims & appeals
 Medicare Prescription "Extra Help Program" Link 2014
Supplemental Medicare prescription program for patients with resources limited to $13,440 for an individual or $26,860 for a married couple living together as of 2014
 Needy Meds.org
Rx Assistance database of programs; National non-profit organization that maintains a website of free information on programs that help people who can't afford medications and healthcare costs
 Partnership for Prescription Assistance
The Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free.
 Prescription Assistance 360 - Patient advocacy clearing house for prescription support
Connect patients to over 270 Patient Assistance Programs through website designed by Patient Advocates, and a single point of contact
 Rivaroxaban (Xarelto)
Comprehensive support program to help patients start and stay on therapy

Patient Self Testing

 Patient Self-Testing Overview, Patient Info Guide (Clot Connect 2013)
7 page document from Clot Connect, 2013 explaining merits of home testing, current devices and considerations for choosing this testing method.
 Patient Self-Testing Presentation, Ansell PowerPoint, Oct 2012
 Patient Self-Testing/Management Consensus Statement AC Forum, 2008
Rationale for Wider Implementation of Patient Self-Testing • Patient Self-Testing Costs and Related Reimbursement • Practical Guidelines for Implementation of Patient Self-Testing • Summary of Consensus Panel Recommendations
 Self Testing; Home Machine Patient Education Material
10 page brochure from Brigham & Women's Hospital, explaining all aspects of home testing including patient quiz and agreement

Patient Treatment Care Plans

 Anticoagulation Forum Outpatient Consensus Statement 2008
10 page document from the Anticoagulation Forum providing recommendations, policies, and procedures pertaining to the provision of optimized anticoagulation therapy designed to achieve desired clinical endpoints while minimizing the risk of anticoagulant-related adverse outcomes (principally bleeding and thrombosis).
 Antithrombotic Therapy and Prevention of Thrombosis, AT 9 Summary 2012 (CHEST)
 Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation    NEW
Journal of Internal Medicine, 2015; A. M. Shields & G. Y. H. Lip; Review of how to choose the right DOAC for patients with non-valvular AF; includes risk assessment, pharmacology considerations, a decision tree and case-based examples
 Delivery of Optimized Inpatient Anticoagulation Therapy: Consensus Statement from the Anticoagulation Forum, May 2013
From the AC Forum, guidelines designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. Table 8 in the article includes a “Care Transitions Checklist”
 Guidance document for Switching Between Agents, UNMH, May 2015    NEW
3 page guidance document includes reasons for switching, recommendations and dosing guidelines, May 2015
 How I treat anticoagulated patients undergoing elective procedure or surgery (Spyropoulos & Douketis, 2012)
Article from Blood outlining risk, strategy and management as it pertains to patients on anticoagulants
 Management of Venous Thromboembolism: Clinical Guidance from the AC Forum, January 2016    NEW
New practical guidance from AC Forum, developed by 58 leading international experts Free Open Access to all manuscripts published January 2016 in Journal of Thrombosis and Thrombolysis
 Managing Multiple Health Problems in Older Adults, Amer. Geri. Society 2012
 Neuraxial Management; University of Washington, Seattle, 2014    NEW
 Patient Preferences and Values in Antithrombotic Care, CHEST 2012
 Predicting the risk of recurrent venous thromboembolism (VTE), 2/2015    NEW
Reviews the impact of clinical and laboratory risk factors for recurrent VTE; J of Thrombosis and Throbolysis; Michael B. Streiff
 Transitioning to and from the direct oral anticoagulants: a management strategy for clinicians    NEW
J Thromb Thrombolysis Feb 2014, Elsayed Abo-Salem,Richard Becker 8-page article focuses on transitioning to and from DOACs employing a practical pharmacokinetic- and pharmacodynamic-based approach.
 Treatment of Venous Thromboembolism, 2014 JAMA
Feb 2014 JAMA, Wells, Forgie, Rodger; Review of acute, long-term and extended VTE and an explanation of evidence-based findings and relevance; includes treatment choices, decision trees
 Universal, class-specific and drug-specific reversal agents for the direct oral anticoagulants, 2015    NEW
J Thromb Thrombolysis, 2015, 4 page article by Dr. Jack Ansell, outlining 3 DOAC antidotes in development and their impact on the use of DOACs

Pediatric Patient Care

 CHEST 2012 Antithrombotic Therapy in Neonates and Children
2012 CHEST 65 page supplement specifically addressing optimal strategies for the management of thrombosis in neonates and children
 Pediatric Anticoag Guidelines from The Children's Hospital of Philadelphia, 2014
multiple guidelines including anticoagulation medication guidelines for management of pediatric blood clots/thromboembolic disorders created by The Children's Hospital of Philadelphia & Dr. Dr. Leslie Raffini, 2014; Heparin, Enoxaparin & Coumadin included
 Pediatric Enoxaparin Treatment Order Set
Pediatric Enoxaparin Treatment (Low-Molecular Weight Heparin) order Set from Intermountain Healthcare; note not to be used to treat patients with serious hemorrhagic complications
 Pediatric Heparin and Enoxaparin Protocols, Vanderbilt, 2012
Protocol that includes dosing, monitoring and reversal for heparin and enoxaparin and conversion between drugs; 2012;Robert F. Sidonio, Jr,MD,MSc, Vanderbilt U School of Medicine
 Pediatric Heparin Dosing Guideline, UW Health 2012
2012 protocol from UW Health, includes recommendations for dosing, monitoring and dose adjustments for pediatric patients;Sara Shull, PharmD, MBA, Drug Policy Manager, [email protected] ; University of Wisconsin Hospital and Clinics
 Pediatric Warfarin Protocol, Vanderbilt 2012
Protocol including dosing, monitoring and reversal of warfarin in pediatrics; created by Robert F. Sidonio, Jr, MD, MSc, Vanderbilt U School of Medicine

Special/High-Risk Patient Populations

 Antithrombotic Reversal Guideline, UNMH, November 2015
5 page reversal guideline by specific agent, includes decision tree; approved by University of new Mexico Hospital Anticoagulation Subcommittee
 Cancer Guidelines - ASCO June 2013
recommendations about prophylaxis and treatment of venous thromboembolism (VTE)in patients with cancer; an American Society of Clinical Oncology Clinical Practice Guideline Update
 Cancer Guidelines - International 2012
International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer published in 2012 Journal of Thrombosis and Haemostasis
 DOACs in the elderly, May 2014    NEW
8 page article from Jrl of American Geriatrics Soc.; evaluating the efficacy and safety of new oral anticoagulants in elderly adults; Partha Sardar MD1,*, Saurav Chatterjee MD2, Shobhana Chaudhari MD1 andGregory Y. H. Lip MD3
 Dosing of Target-Specific Oral Anticoagulants in Special Populations, 2015    NEW
literature reivew and synopsis of critical analysis for dosing of DOACs recommendations in special population groups. Annals of Pharmacotherapy, 2015 Morrill, Willett
 Guidance document for Switching Between Agents, UNMH, May 2015    NEW
3 page guidance document includes reasons for switching, recommendations and dosing guidelines, May 2015
 How I treat anticoagulated patients undergoing elective procedure or surgery (Spyropoulos & Douketis, 2012)
Article from Blood outlining risk, strategy and management as it pertains to patients on anticoagulants
 How I treat heparin-induced thrombocytopenia; 10 page article in Blood, 2012, Cuker & Cines
10 page article covering evaluation and management of patients with heparin-induced thrombocytopenia. Includes methods to minimize misdiagnosis and unnecessary treatment and investigation of ways to improvement of the diagnosis, Jan 2012 Blood
 Inferior vena cava filters: current best practices    NEW
J Thromb Thrombolysis (2015) Anita Rajasekhar
 Interventional Spine & Pain Procedures in Patients on Antiplatelet & Anticoagulant Medications, 2015    NEW
ASRA guidelines, specifically for interventional spine and pain procedures in patients on antiplatelets/anticoagulants from American Society of Regional Anesthesia & Pain Medicine, European Society of Regional Anaesthesia & Pain Therapy, American Academy of Pain Medicine, the International Neuromodulation Society, North American Neuromodulation Society, World Institute of Pain; Narouze,Benzon, Provenzano, Buvanendran,De Andres, Deer, Rauck, Huntoon, American Society of Regional Anesthesia & Pain Medicine
 Low Molecular Weight Heparins in Special Populations: Renal Impairment and Obesity
Annals of Pharmacology:practical recommendations for the use of LMWHs as prophylaxis & treatment of VTE & acute coronary syndromes in patients with impaired renal function or obesity; 2009 Nutescu,Spinler, Wittkowsky, and Dager
 Managing Multiple Health Problems in Older Adults, Amer. Geri. Society 2012
 Managing unusual presentations of VTE, 2015    NEW
Management of venous thrombosis occurring in the splanchnic veins and in the cerebral veins; J Thromb Thrombolysis (2015) Ageno
 Monitoring LMWH During Pregnancy
2013 Chart from UW Medicine offering guidance for monitoring of LMWHs during 3rd trimester of pregnancy
 Neuraxial Management; University of Washington, Seattle, 2014    NEW
 Obstetric Consensus Statement from NPMS on Venous thromboprophylaxis in pregnancy 10/16    NEW
Overview of critical clinical practices suggested for implemention in every maternity unit -- four domains: Readiness, Recognition, Response, and Reporting and Systems Learning; by The American College of Obstetricians and Gynecologists October, 2016
 Pregnancy-Related Venous Thromboembolism, Jrl of Pharmacy Practice, April 2014    NEW
11 page article in Journal of Pharmacy Practice, April 2014, Emily M. Armstrong, Jessica M. Bellone, Lori B. Hornsby, Sarah Treadway and Haley M. Phillippe
 Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy,
ASRA consensus statements represent collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation; based on case reports, clinical series, pharmacology, hematology, and risk factors for surgical bleeding; published in Regional Anesthesia and Pain Medicine, Jan-Feb 2010;Horlocker,Wedel, MD,Rowlingson, Enneking,Kopp,Benzon, Brown, Heit,Mulroy,Rosenquist,Tryba,Yuan
 The Post Thrombotic Syndrome, Vazquez & Kahn 2010
Hematology 2010 article outlining PTS as a complication of DVT touching on risk factors, prevention & treatment
 Universal, class-specific and drug-specific reversal agents for the direct oral anticoagulants, 2015    NEW
J Thromb Thrombolysis, 2015, 4 page article by Dr. Jack Ansell, outlining 3 DOAC antidotes in development and their impact on the use of DOACs
 UNMH HIT Guideline    NEW
one page guideline with recommendations for evaluation using 4T scoring and testing options

Specialty Testing/Monitoring

 Clinical Guideline Methods, evidence and recommendations 2012, National Institute for Health and Clinical Excellence (NICE)
Clinical Guideline; Methods, evidence and recommendations; 2012
 Heparin-induced thrombocytopenia CHEST 2012
 How I treat heparin-induced thrombocytopenia; 10 page article in Blood, 2012, Cuker & Cines
10 page article covering evaluation and management of patients with heparin-induced thrombocytopenia. Includes methods to minimize misdiagnosis and unnecessary treatment and investigation of ways to improvement of the diagnosis, Jan 2012 Blood
 Influence of DOACs on Thrombopilia Testing    NEW
1 page table outlining influence of the New Oral Anticoagulants on coagulation tests; modified by Linda Kelly, Presbyterian Healthcare from Lindhoff-Last E, ISTH 2013: “Measurement of NOACs and influence on coagulation assays”
 Management of Confirmed HIT, UW Medicine 2013
One page decision tree for confirmed case of HIT, created by the University of Washington, UW Medicine HIT Management Task Force, July 2013
 Management of Suspected HIT, UW Medicine 2013
One page decision tree for treatment of suspected HIT, UW Medicine HIT Management Taskforce September 2013
 Pregnancy-Related Venous Thromboembolism, Jrl. of Pharmacy Practice, April 2014    NEW
 Sydney Criteria for Thrombophilia Testing
 Thrombophilia Testing Chart
 Thrombophilia: Clinical-Practical Aspects, 2015 J of Thromb Thrombolysis
J Thromb Thrombolysis (2015)
 UNMH HIT Guideline    NEW
one page guideline with recommendations for evaluation using 4T scoring and testing options
 Warfarin Pharmacogenetic Testing Resource, 2013
available evidence and existing recommendations as to the use of pharmacogenetic (PG) testing to guide warfarin dosing

Valvular Heart Disease

 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease    NEW
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
 ACCP Guidelines for Valvular Heart Disease, 2012
 Efficacy and safety of early parenteral anticoagulation as a bridge to warfarin after mechanical valve replacement    NEW
Thrombosis and Haemostasis 112.6/2014; 3 page article, Joseph G. Mathew1; Alex C. Spyropoulos2; Arif Yusuf1; Jessica Vincent1; John Eikelboom1,; Olga Shestakovska; Stephen Fremes; Joseph Noora; Linrui Guo5; Mark Peterson; Menaka Pai; Richard Whitlock
 European Journal of Cardio-Thoracic Surgery Guidelines on the Management of Valvular Heart Disease 2012

VTE

 Algorithmic Approach to Treating Upper Extremity DVT, AHA 2012
 Antithrombotic Therapy and Prevention of Thrombosis, AT 9 Summary 2012 (CHEST)
 Aspirin for Secondary Prevention of Unprovoked VTE, 2015    NEW
2 page article Kochawan Boonyawat, Mark A. Crowther; J Thromb Thrombolysis (2015)
 HIT Pocket guide 2013; ASH
Quick reference guide 2013, Adam Cuker, Mark A. Crowther adapted from 2009 CHEST Guidelines
 IMPROVE VTE and bleeding risk calculator    NEW
online calculator/Risk Assessment Tool for estimating risk of VTE; from IMPROVE, an international observational database of outcomes for patients who are hospitalized for an acute medical illness. IMPROVE includes 52 hospitals in 12 countries that enrolled a total of 15,156 patients.
 Management of venous thromboembolic diseases & the role of thrombophilia testing (NICE Summary)
UK based National Institute for Health and Care Excellence (NICE)Summary 40 page evidence-based guideline for VTE management
 Management of Venous Thromboembolism: Clinical Guidance from the AC Forum, January 2016    NEW
New practical guidance from AC Forum, developed by 58 leading international experts Free Open Access to all manuscripts published January 2016 in Journal of Thrombosis and Thrombolysis
 Post-Thrombotic Syndrome Visual Assessment Guide
 Pregnancy-Related Venous Thromboembolism, Jrl. of Pharmacy Practice, April 2014    NEW
 The Post Thrombotic Syndrome, Vazquez & Kahn 2010
Hematology 2010 article outlining PTS as a complication of DVT touching on risk factors, prevention & treatment
 Treatment of Venous Thromboembolism, 2014 JAMA    NEW
9 page article in JAMA covering etiology of VTE and the 3 phases of VTE treatment: acute (first 5-10 days), long-term (from end of acute treatment to 3-6 months), and extended (beyond 3-6 months) and treatment options, Philip S.Wells, MD, FRCP(C), MSc; Melissa A. Forgie,MD, FRCP(C), MSc; Marc A. Rodger,MD, FRCP(C), MSc
 VT Management – Adult - Ambulatory/Emergency Department – Clinical Practice Guideline    NEW
From U of Wsc. Health, 18 page guideline, 2015 for VTE Mangement
 VTE Implementation Toolkit    NEW
Toolkit for implementing and measuring evidence- based VTE prophylaxis strategies from Society of Hospital Medicine, 2016
 VTE Prophylaxis Guideline, UNMH, 2014
 VTE Prophylaxis Pocketcard
 Wells' - Criteria for Pulmonary Embolism / PE Online Calculator
 Wells' Criteria for DVT - MD Online Calculator
online calculator of Wells' Score for risk of DVT