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PRACTICE AIDComparison Chart for Direct Oral Anticoagulants WithEfficacy and Safety Data in Cancer-Associated VTE1This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.Generic?FDA approvalFDA approved avaysa)NoNoNoJuly 2011December 2012January 2015 Stroke preventionin nonvalvular AF Stroke preventionin nonvalvular AF Stroke preventionin nonvalvular AF Treatment andsecondaryprevention of DVTand PE Treatment andsecondaryprevention of DVTand PE Treatment andsecondaryprevention of DVTand PE VTE preventionafter hip and kneereplacementsurgery VTE preventionafter hip and kneereplacementsurgeryDrug imageAvailablestrengths10-mg, 15-mg, or20-mg tablet5-mg or 2.5-mg tablet15-mg, 30-mg, or60-mg tabletAccess the activity, “Taking a New Look at Cancer-Associated Venous Thromboembolism: How Is EmergingEvidence Influencing Guidelines & Practice?” at PeerView.com/TGQ40.
PRACTICE AIDComparison Chart for Direct Oral Anticoagulants WithEfficacy and Safety Data in Cancer-Associated VTE1Rivaroxaban(Xarelto)Dosing frequencyOnsetKidney functionOnce dailyApixaban(Eliquis)Twice dailyEdoxaban(Savaysa)Following a 3-week loading period of15 mg twice daily for PE and DVTFollowing a 1-week loading period of10 mg twice daily for PE and DVTOnce dailyFastA few hoursFastA few hoursFastA few hoursYesYesYesPatients with CrCl 25 wereexcluded from clinical trialsKidney function affectsthe dosageRivaroxaban should be takenwith dinnerNoNoFewFewFewRoutine lab monitoringNoNoNoReversal agentsYesYesMay use prothrombin complexconcentrates in emergenciesFood effectDrug interactionsKidney function affects the dosageYesAndexanet alfaAndexanet alfaSoonAF: atrial fibrillation; CrCl: creatinine clearance; NATF: North American Thrombosis Forum; PE: pulmonary embolism; VTE: venous thromboembolism.1. Anticoagulant-Comparison-Chart-May2018 FINAL.pdf. Accessed April 16, 2019.Access the activity, “Taking a New Look at Cancer-Associated Venous Thromboembolism: How Is EmergingEvidence Influencing Guidelines & Practice?” at PeerView.com/TGQ40.
PRACTICE AIDKhorana VTE Risk-Assessment Tool1This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.Khorana Predictive Model1-3Patient CharacteristicRisk ScoreSite of cancerVery high risk (stomach, pancreas)High risk (lung, lymphoma, gynecologic, bladder, testicular)21Prechemotherapy platelet count 350 x 109/L1Hemoglobin level 100 g/L or use of red cell growth factors1Prechemotherapy leukocyte count 11 x 109/L1BMI 35 kg/m21TOTAL RISK FACTOR SCORE:Total Risk Factor Score01, 2 3Risk CategoryLowIntermediateHigh1. Khorana AA et al. Blood. 2008;111:4902-4907. 2. Khorana AA. Am J Hematol. 2012;87:S82-S87. 3. Riondino S et al. Cancers (Basel). 2019;11:95.Access the activity, “Taking a New Look at Cancer-Associated Venous Thromboembolism:How Is Emerging Evidence Influencing Guidelines & Practice?” at PeerView.com/TGQ40.
PRACTICE AIDDecision Guide for Using Direct OralAnticoagulants With Efficacy and SafetyData in Cancer-Associated VTE1This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.Completed initial VTEacute treatment inambulatory patientSummaryAlgorithmNonstable disease;high risk or at high riskof recurrenceYesNoLMWHPatient averse to usinginjectable therapyor is noncompliantLMWHNoYesAbility totolerateoral intakeApixaban,edoxaban,rivaroxabanYesDosing scheduleNoRenal functionDaily: edoxaban,rivaroxabanBID: usendoscopicjejunostomyTotal HHepatic functionCrCl25-30CirrhosisConsiderapixabanDrug interactionsReview druginteractionsLMWHBID: twice a day; CrCl: creatinine clearance; LMWH: low-molecular-weight heparin; VTE: venous thromboembolism.1. Smrke A, Gross PL. Front Med (Lausanne). 2017;4:142.Access the activity, “Taking a New Look at Cancer-Associated Venous Thromboembolism:How Is Emerging Evidence Influencing Guidelines & Practice?” at PeerView.com/TGQ40.
PRACTICE AIDConsiderations in PatientsWith Renal ImpairmentThis Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.Use of Anticoagulant Class According to Renal Function1EGFR (mL/min)UFHLMWHsWarfarinDOACs oxaban doseadjustmentYes Dose adjustmentsmay be needed;bioaccumulationpossible Enoxaparin usewith cautionYesUsecontraindicatedoutside selectedpatients withappropriatemonitoring15-29 15Yes Rivaroxabanand dabigatrancontraindicated Apixaban usewith cautionYesRivaroxabanand dabigatrancontraindicatedDOAC: direct oral anticoagulant; LMWH: low-molecular-weight heparin; UFH: unfractionated heparin.1. Ribic C, Crowther M. Hematology Am Soc Hematol Educ Program. 2016;2016:188-195.Access the activity, “Taking a New Look at Cancer-Associated Venous Thromboembolism:How Is Emerging Evidence Influencing Guidelines & Practice?” at PeerView.com/TGQ40.
Comparison Chart for Direct Oral Anticoagulants With Efficacy and Safety Data in Cancer-Associated VTE 1 PRACTICE AID Access the activity, Taking a New Look at Cancer-Associated Venous Thromboembolism: How Is Emerging . Comparison Chart for Direct Oral Anticoagulants With Efficacy and Safety Data in Cancer-Associated VTE 1 AF: atrial .
